Principles of People-Centred Wheelchair Provision

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Original Editor - Stacy Schiurring

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Introduction

An estimated 80 million people require a wheelchair to assist their mobility, with this number projected to grow as populations age and chronic health conditions become more prevalent. Ensuring that these individuals receive not just a wheelchair, but an appropriate wheelchair delivered through a structured service, is a global health priority.

The WHO 2023 Wheelchair Provision Guidelines are a set of seven evidence-based recommendations, four at the service level and three at the system level, designed to guide the delivery of appropriate wheelchair services across all settings, populations, and wheelchair types worldwide. Developed in collaboration with the International Society for Prosthetics and Orthotics (ISPO) and the International Society of Wheelchair Professionals (ISWP), they represent an update to the 2008 guidelines and apply equally across low-, middle-, and high-income country contexts. The four service steps are the clinical foundation of wheelchair provision and are explored in depth on the Introduction to Wheelchair Service Provision Physiopedia Page.

This Physiopedia Page focuses on three equally important dimensions that sit alongside and support the four-step model: the principles that shape how services are delivered, the people responsible for delivering them, and the broader systems that make sustained, high-quality provision possible. Together, these elements provide the wider context that rehabilitation professionals need to practise effectively, advocate confidently, and contribute to services that are equitable, person-centred, and sustainable.

Principles of People-Centred Wheelchair Provision

The WHO 2023 guidelines emphasise that wheelchair services must be people-centred and responsive to individual needs. The following principles support this approach:

Meaningful participation. Wheelchair users and their families must be active partners throughout the entire process, from assessment through follow-up. Their preferences, priorities, and lived experience should inform decision-making at every step.

Holistic assessment. Assessment must consider the person within their environment and social context, not merely their impairment or mobility limitation. Cultural factors, personal goals, and social participation objectives are as important as physical measurements.

Equity and inclusion. Wheelchair provision systems should be designed to ensure the most vulnerable people and communities receive additional support to achieve the same outcomes as others. This includes attention to gender considerations (recognising different needs and barriers faced by women and girls), age-appropriate provision (children, working-age adults, older persons), diverse impairment types and severity levels, and socioeconomic factors that create access barriers.

Continuity of care. Wheelchair provision is not a single event, but an ongoing process that requires long-term support, periodic reassessment, and responsiveness to changing needs across the lifespan.

The Role of Trained Personnel

The WHO guidelines make it clear that positive outcomes in wheelchair provision depend on appropriately trained personnel delivering the service steps. Effective wheelchair provision requires a combination of clinical knowledge, technical skills, and person-centred communication abilities:

Core competencies. Personnel involved in wheelchair provision require competencies across multiple domains. Skills in assessment and evaluation enable practitioners to understand users' needs, abilities, and contexts. Wheelchair product knowledge, including understanding features, functions, and the suitability of different wheelchair types, is equally important. Fitting and adjustment skills allow practitioners to optimise the interface between user and equipment, while training and education methods enable them to provide users with the necessary skills and knowledge to use their wheelchair safely. Problem-solving abilities are needed to address the complex needs and unique circumstances that arise in clinical practice, and communication and counselling skills support the collaborative relationship at the heart of person-centred care. A thorough understanding of pressure injury aetiology and prevention is vital, given the serious risks wheelchair users face. Finally, knowledge of local context, available resources, and referral pathways enables practitioners to navigate systems and connect users with additional supports when needed.

The multidisciplinary team. Wheelchair provision often requires input from multiple professionals working collaboratively to address users' diverse needs. Central to this team is the wheelchair user themselves. They bring unique insight of their own body, environment, daily routines, and goals, their input is not merely welcomed but essential to every decision made throughout the provision process. Physiotherapists and occupational therapists typically lead the assessment and prescription process, drawing on their expertise in movement, function, and activity participation. Rehabilitation engineers and technicians contribute essential knowledge about equipment modifications, custom fabrication, and technical problem-solving. Physicians and nurses provide medical oversight, particularly for users with complex health conditions or those at high risk for secondary complications. Social workers may assist with funding applications, community integration, and psychosocial support. Equipment suppliers and vendors serve as important partners in product procurement, maintenance, and repair services. Increasingly, peer mentors with lived experience of wheelchair use are recognised as valuable team members, offering unique insights, role modelling, and emotional support. Effective teamwork and clear communication amongst all these stakeholders are essential for achieving optimal outcomes, and can be supported through established protocols for information sharing, collaborative decision-making, and coordinated service delivery.

Ongoing professional development. The field of wheelchair provision continues to evolve with new products, technologies, and evidence, requiring ongoing professional development. Formal training programmes provide foundational knowledge and standardised approaches to service delivery. Continuing education opportunities enable practitioners to stay current with emerging evidence, new technologies, and evolving best practices. Communities of practice facilitate knowledge sharing amongst peers, allowing practitioners to learn from others' experiences, discuss challenging cases, and develop innovative solutions to common problems. Clinical supervision and mentorship support professional growth, particularly for entry-level practitioners. This commitment to lifelong learning ensures that wheelchair services continue to improve and that practitioners maintain the competencies necessary to deliver high-quality, evidence-based care.

System-Level Considerations

The WHO 2023 guidelines include three system-level recommendations that support the four service steps. While the service steps define what must be done for each individual wheelchair user, the system-level recommendations address the conditions that must be in place for services to function consistently, equitably, and sustainably. Individual clinicians cannot achieve optimal outcomes in isolation, effective service delivery requires the support of broader systems.

Underpinning all three system-level recommendations is the need for supportive policies and sustainable funding. The guidelines call for policies that address product and service standards, funding mechanisms, and recognition of the right to mobility as articulated in the Convention on the Rights of Persons with Disabilities. Funding models must cover not only wheelchair products but also the personnel time required for assessment, fitting, training, and follow-up, alongside ongoing costs for maintenance, repairs, and replacement. While these decisions are often made at governmental levels, rehabilitation professionals play a crucial role in advocacy by providing evidence of need, demonstrating service effectiveness, and participating in policy development processes.

System-Level Recommendation 1: Competent Workforce

Wheelchair provision roles must be performed by people who have role-specific competencies (Strong recommendation, moderate certainty evidence).

The WHO defines competency as the ability to integrate skills, knowledge, attitudes, and behaviours to successfully achieve a desired result. The guidelines identify three broad categories of wheelchair provision roles: identification and referral; service delivery (clinical and technical); and management. Each role requires specific competencies, and sufficient numbers of appropriately trained personnel must be available to fulfil them.

In many contexts, building this workforce capacity requires task-shifting strategies: developing specific competencies amongst personnel who may not be traditional rehabilitation professionals, such as nurses, community health workers, or peer mentors. This is particularly important in areas with limited access to physiotherapists, occupational therapists, or rehabilitation engineers. Appropriate preparation and ongoing supervision are essential regardless of the role.

System-Level Recommendation 2: Seamless Referral and Access

Wheelchair provision, including identification of need, referral, and service delivery, should be seamless and integrated across all levels of health systems and other relevant sectors (Strong recommendation, very low certainty evidence).

The WHO describes seamless wheelchair provision as characterised by consistency, continuity, and coordination of identification, referral, and service steps, delivered in a timely manner with minimal barriers and delays. Integrated means that wheelchair provision is part of a comprehensive health service at all levels and, as appropriate, part of other relevant sectors such as educational, vocational, or social welfare.

In practice, this means that a child identified as needing a wheelchair through a community screening programme should have an established pathway to assessment services, with coordination across health, education, and social sectors. Similarly, an adult with a progressive condition should be able to access reassessment and equipment updates without navigating complex bureaucratic barriers. Integrated systems help prevent individuals from falling through gaps between services and ensure continuity of care.

System-Level Recommendation3: Systematic Evaluation

Processes to measure and evaluate the performance of wheelchair provision should be implemented to inform ongoing strengthening of people-centred, equitable access to appropriate wheelchairs (Conditional recommendation, very low certainty evidence).

The WHO distinguishes between measurement (the routine collection of information about service users, personnel, provision processes, and products) and evaluation (which involves reviewing that information to determine whether wheelchair provision is meeting, exceeding, or falling short of desired targets). Strengthening means making changes to wheelchair provision when evaluation indicates a weakness.

Data collection should cover service user outcomes (eg. mobility, function, and participation), personnel competencies and training needs, provision processes and wait times, product quality and durability, and equity of access across different populations. This last dimension is particularly important: evaluation that highlights disparities ensures that vulnerable groups are not systematically excluded from services.

Conclusion

The four service steps (select, fit, train, and follow-up) provide the clinical framework for wheelchair provision, but their effective delivery depends on much more than technical competence alone. The principles of people-centred care, the expertise of a well-trained and collaborative multidisciplinary team, and the support of robust systems and policies together determine whether wheelchair services are truly equitable, sustainable, and responsive to the needs of every individual. For rehabilitation professionals, understanding this broader context is not peripheral to clinical practice, it is integral to it. Advocating for people-centred services, contributing to multidisciplinary teams, pursuing ongoing professional development, and participating in service evaluation and policy processes are all part of what it means to deliver high-quality wheelchair provision in any setting.

Resources

Clinical Resources:

• WHO Wheelchair Provision Guidelines (2023)
• Convention on the Rights of Persons with Disabilities