Rachel Cowan, Ph.D., associate professor at the University of Alabama at Birmingham’s Department of Physical Medicine & Rehabilitation and program co-director for UAB’s Spinal Cord Injury Model System, co-chaired the World Health Organization (WHO) Global Wheelchair Service Guidelines Develop Group (GDG) and co-authored the Wheelchair Service Guidelines alongside Kylie Shae and Sarah Sheldon. The Guidelines were official launched at the April 2023 meeting of the International Society for Prosthetics and Orthotics in Guadalajara, Mexico.

In recent decades substantial progress has been made within the wheelchair sector; however, the need to develop global policy and standards for wheelchair provision remained. The U.S. Agency for International Development (USAID) led Wheelchair Stakeholders’ Meeting held in Bangalore, India in 2018, identified establishing global service standards as one of 10 key priorities for the sector. In the same year the World Health Assembly provided specific calls for the development of policy on assistive technology, requesting Member States to contribute to and engage in the development of minimum standards for priority assistive products and services, in order to promote their safety, quality, cost-effectiveness, and appropriateness in Resolution 71.8 (2018) “Improving access to assistive technology”. The new Guidelines promote, inform, and support planning, delivery, and evaluation of wheelchair services within health systems, in order to strengthen equitable access to wheelchair services in diverse contexts by people of all ages with a mobility impairment.

Guideline development at WHO follows a rigorous process of developing PICO (person, intervention, comparator, outcome) questions, performing systematic reviews, and following an Evidence to Decision (EtD) process to ensure the resulting recommendations are based on the best available scientific and practice-based evidence. Due to Dr. Cowan’s extensive scientific knowledge and experience in the area of wheelchair seating and mobility, she has played a substantial role in leading the Guidelines Development Group through the Evidence to Decision (EtD) process. After much research and discussion, she then took the group’s collective input and drafted the recommendations section of the Guidelines.

There were obstacles along the way to compiling data for the guidelines. “The group process was particularly challenging because the GDG members were largely non-academics without scientific training. And, because of COVID, we had to do the majority of the work virtually rather than in person limiting ease of communication and consultation with key stakeholders,” Cowan stated. By the time the group officially met in person at WHO Headquarters in Geneva, Switzerland in October 2022, draft guidelines had been developed, following an in-depth two-year process.

These guidelines provide a set of evidence-based recommendations and best practice guidance to support countries in developing or improving essential wheelchair services. Adoption of these guidelines will support governments in fulfilling their obligation to implement the UN Convention on the Rights of Persons with Disabilities (CRPD) which places responsibility on governments to prioritize the provision of assistive technology for personal mobility. The guidelines will also aid Member States in meeting the Sustainable Development Goals (SDGs), in particular the goal to ensure healthy lives and promote well-being for all at all ages.

Since the launch, the Guidelines have received positive feedback and a strong recommendation for implementation by ECRI Guidelines Trust®. The ECRI Guidelines Trust® (EGT) is a repository of objective, evidence-based clinical practice guidelines. Its purpose is to provide physicians, nurses, other clinical specialties, and members of the healthcare community with current clinical practices to advance safe and effective patient care.