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There is level 4 (from four post-test studies; Boninger et al. 2002; Ritcher et al. 2007; Raina et al. 2012b; Kwarciak et al. 2012) evidence that the typical propulsion stroke patterns used by individuals with spinal cord injury varies across the four stroke patterns regardless of level of injury.

There is level 4 (from one post-test study; Boninger et al. 2002) evidence that the semicircular and double-loop-over propulsion wheelchair stroke patterns reduce cadence and time spent in each phase of propulsion, thus using these patterns may reduce the risk of median nerve injury.

There is level 4 (from two post-test studies; Ritcher et al. 2007; Raina et al. 2012b) evidence that there is no difference in hand rim biomechanics during propulsion between the four stroke patterns. However, there is also level 4 (from two case series studies; Boninger et al. 2002; Kwarciak et al. 2012) evidence that the semicircular and double-loop-over propulsion stroke patterns offer the best combination of biomechanics for propulsion.

There is level 4 (from one post-test study by Raina et al. 2012b) evidence propulsion biomechanics differ between people with paraplegia and tetraplegia with the latter group producing lower wrist velocity prior to contact, less magnitude of force impact, and higher radial force.

There is level 4 (from one post-test study; Feng et al. 2010) evidence that the movements associated with particular patterns may increase the risk of shoulder impingement, with pumping stroke pattern exposing the shoulder to greater risk than the circular pattern.

There is level 4 (from two post-test studies; Kwarciak et al. 2012; Boninger et al. 2002) evidence that the ARC stroke pattern has suboptimal biomechanics, but the lowest muscle demand, therefore holds potential for making it useful for short duration, high force propulsions such during ascending a hill or ramp.

There is level 4 evidence (from two post-test studies; Koontz et al. 2009; Richter et al. 2007a) to suggest that the ARC pattern is the most frequently used propulsion pattern used when ascending a slope greater than 3⁰.

There is level 4 evidence (from one post-test study; Koontz et al. 2009) to suggest that it takes the first three propulsion strokes from a resting positioning to reach steady state velocity and while the ARC pattern is most frequently used for the first stroke, those who change to an under-rim pattern for the subsequent strokes, reach steady state velocities quicker and experience less negative mechanical forces during start up propulsion.

There is level 1b evidence (from two RCT studies by Qi et al. 2018 and Cloud et al. 2017) that seat dump angle affects spinal curvature and scapulothoracic kinematics during wheelchair propulsion; however, the glenohumeral joint may not be affected.

There is level 1b evidence (from one RCT study by Triolo et al. 2013) to suggest that electrical stimulation of the hip flexors and trunk muscles during manual wheelchair propulsion on a level surface may reduce the impact on the upper extremity at the handrim.

There is level 4 (from one post-test study by Koontz et al. 2012) evidence to suggest that when propulsion force and body weight are correlated, propulsion force on a wheelchair dynamometer correlates to propulsion force on a smooth level surface such as a tile floor.

There is level 1b evidence (from one RCT crossover by Goins et al. 2011, one prospective controlled study by Gil-Agudo et al. 2016, three post-test studies by Gil-Agudo et al. 2010, Mercer et al. 2006 and VanLandewijck et al. 1994, and one pre-post study by Gil-Agudo et al. 2014)  that increasing speed/intensity of manual wheelchair propulsion results in an increase in cadence, increases in shoulder forces primarily in a posterior direction and, changes in elbow translation all of which may contribute to the development of upper extremity pain. However, no differences in shoulder ultrasound parameters were observed (Gil-Agudo et al. 2016).

There is level 1b evidence (from one RCT by Qi et al. 2018) that faster propulsion requires significantly higher propulsive muscle activity and energy expenditure and that faster propulsion requires more muscle activity in the early push phase and in the transitions between push and recovery.

There is level 4 evidence (from one post-test study, Bregman et al. 2009) to suggest that tangential propulsion forces are higher compared to total propulsion forces for people with paraplegic and tetraplegic levels of spinal cord injury as well as for people without a disability.

There is level 4 evidence (from one pre-post study, Russell et al. 2015) that suggests that the forces at the shoulder during fast propulsion are dependent on the forces around the centre of mass at the forearm and upper arm and therefore the position of the upper extremity during the propulsion cycle has a significant effect on shoulder forces.

There is level  4 evidence (from one post-test study, Dallmeijer et al. 1998) to suggest that there are differences in the efficiency of force application at the hand rim between participants with paraplegia and tetraplegia which are a result of differences in available muscle movement/function; force application at the hand rim contributes to a large degree to overall propulsion mechanical efficiency.

There is level 4 evidence (from one post-test study by Mercer et al. 2006) that higher body mass increases shoulder forces and moments, therefore may be associated with a higher risk of propulsion related injuries.

There is level 4 evidence (from one post-test study by Yang et al 2012) that back rest height influences range of motion used for propulsion, cadence and length of stroke used during propulsion.

There is level 4 evidence (from two post-test studies by Yang et al. 2012 and Raina et al. 2012a) that to propel up a slope cadence increases and a greater range of motion is used at the shoulder and scapula.

There is level 1b evidence (from one RCT by Julien et al. 2013 and one prospective control study by Rodgers et al. 2000) to suggest that trunk and neck flexion during propulsion significantly changes propulsion forces at the handrim and shoulder for people with paraplegia or tetraplegia.

There is level 2 evidence (one prospective controlled trial, Kim et al. 2015) that indicates the sternocleidomastoid muscle is more active during propulsion in people with thoracic level paraplegia than in non-disabled people.

There is level 4 evidence (from one post-test study by VanLandewijck et al. 1994) to suggest that different muscles are primarily active in the push phase than in the recovery phase and that the onset of the different muscle activity does not coincide with the start of each phase.

There is level 2 evidence (from one cohort study, Jayaraman et al. 2015) to suggest that the change in directions during the recovery phase of propulsion result in high forces at the shoulder, (termed jerk) and varies by the type of stroke pattern used and the presence of shoulder pain.

There is level 4 evidence (from one post-test study by Gil-Agudo et al. 2010) that the predominant shoulder force during the recovery phase is anterior and is greater than the posterior force exhibited in the push phase of propulsion.

There is level 1b evidence (from one RCT by Gil-Agudo et al. 2014 and one post-test study by Ambrosia et al. 2005) to suggest that both stretching and strengthening of the shoulder muscles and training for optimal wheelchair propulsion techniques are needed as part of rehabilitation.

There is level 4 evidence (from one post-test study, Gagnon et al. 2016) that anterior and lateral flexion trunk strength, anterior seated reaching distance, and shoulder, elbow, and handgrip strength are moderately or strongly correlated with results of performance-based manual wheelchair propulsion tests.

There is level 4 evidence (from one post-test study by Soltau et al. 2015 ) to suggest that there are minimal kinentic and kinemtic differences between left and right upper extremity propulsion, therefore propulsion effort can be considered symmetrical.

There is level 4 evidence (from one post-test study; Richter et al. 2007b) that wheeling cross slope results in increased loading on users’ arms and may lead to overuse injuries.

There is level 4 evidence (from one post-test study by Nagy et al. 2012) that advanced wheelchair skills require greater peak forces at the hand rim, however there is level 4 (from one  post-test study by LaLumiere et al. 2013b) evidence that wheelies require a mean peak hand rim force similar to that of wheelchair propulsion.

There is level 4 evidence (from one post-test study by LaLumiere et al 2013a) that ascending curbs of increasing height increases the mechanical and muscular demands at the shoulder and elbow joints placing these joints at risk of injury especially if adequate strength in the associated muscles is not present.

There is level 4 evidence (from one post-test study by Hurd et al. 2008) upper limb asymmetries exist in manual wheelchair propulsion with greater asymmetry in outdoor versus laboratory (tile floor and dynamometer) conditions.

There is level 4 evidence (one  post-test study by Morrow et al. 2010) that the daily life and mobility activities of a push-up, ramp propulsion and the start phase of propulsion place the larger estimated loads on the shoulder and use greater shoulder abduction and extension moments compared to level propulsion.

There is level 2 evidence (from one lower RCT study by Martin-Lemoyne et al. 2017) that mechanical and muscular demands as well as perceived upper limb effort are significantly reduced when ascending a steep ramp with the assistance of a mobility assistance dog compared to without.

There is level 4 evidence (from one pre-post study; Pierret et al. 2014) that suggests the physiological demands of propulsion increase with increasing cross slopes beyond 2%, and that slopes greater than 8% significantly pose significant challenges both physiologically and physically.

There is level 4 evidence (from four post-test studies, Mulroy et al. 2005; Samuelsson et al. 2004; Boninger et al. 2000; Freixes et al. 2010) that the more forward the rear wheel is positioned, the greater the improvement in pushrim biomechanics, shoulder joint forces, push frequency, speed, acceleration and stroke angle.

There is level 2 evidence (from one prospective controlled study; Bednarczky & Sanderson, 1995) that adding 5-10 kg to the weight of a particular wheelchair will not affect the wheeling style under level wheeling, low speed conditions.

There is level 4 evidence (from two pre-post studies; Beekman et al. 1999 and Parzaile 1991) that the use of lighter weight wheelchairs results in improved propulsion efficiency for those with SCI particularly at the start of propulsion.

There is level 4 evidence (from two post-test studies; Boninger et al. 1999; Collinger et al. 2008) that user weight is directly related to pushrim forces, the risk of median nerve injury and the prevalence of shoulder pain and injury.

There is level 2 evidence (from one randomized controlled trial; Vorrink et al. 2008) that the use of high-performance wheels verses standard steel-spoked wheels was no more effective in reducing spasticity or affecting comfort by absorbing vibration forces when wheeling.

There is level 4 evidence (from one post-test study; Garcia-Mendez e t al. 2013) to suggest that whole body vibration exposure for people who use manual wheelchairs are within or above the health caution zone established by ISO.

There is level 4 evidence (from one post-test study; Sawatsky et al. 2005) that tire pressure effects energy expenditure only after the tire has been deflated by 50%.

There is level 4 evidence (from one pre-post study; Richter et al. 2005 and one post-test study; Richter et al. 2006) that a flexible or compliant hand rim can reduce impact forces and reduce wrist and finger flexor activity during wheelchair propulsion.

There is level 4 evidence (from one pre-post study; Richter et al. 2005 and one post-test study; Richter et al. 2006) that flexible or compliant hand rims are found to be acceptable to people who propel manual wheelchairs, with perceived benefits of comfort, reduced upper extremity pain and improved propulsion.

There is level 4 evidence (from one pre-post test study; Corfman et al. 2003) that the use of a PAPAW will reduce upper extremity ROM in individuals with paraplegia during wheelchair propulsion.

There is level 4 evidence (from three pre-post test studies; Algood et al. 2005; Cooper et al. 2001; Fitzgerald et al. 2003) that use of a PAPAW may improve the ability of individuals with tetraplegia to use their wheelchair in a variety of environments and for typical activities.

There is level 4 evidence (from one pre-post test study; Cooper et al. 2001) that the use of a PAPAW may reduce metabolic energy costs for individuals with paraplegia during propulsion and has higher ergonomic rating by users.

There is level 4 evidence (from one pre-post study; Algood et al. 2004) that the PAPAW reduces upper extremity ROM in individuals with tetraplegia during wheelchair propulsion. Metabolic energy expenditure and stroke frequency may be reduced.

There is level 2 evidence (from one low level RCT study; Guillon et al. 2015) that PAPAW results in decreased oxygen consumption and heart rate compared to manual wheelchairs.

There is level 1b evidence (from one randomized controlled trial; Nash et al. 2008) that the use of PAPAW allows individuals with a spinal cord injury (paraplegia and tetraplegia levels) who have long standing shoulder pain to propel their wheelchair further while decreasing energy costs and perceived exertion.

There is level 1b evidence (from one randomized controlled trial; Giesbrecht et al. 2009) that for individuals requiring power mobility, the pushrim-activated, power assisted wheelchair may provide an alternative to power wheelchair use.

There is level 1b (from one blinded RCT study by Rice et al. 2013; one RCT study by Rice et al. 2013; one prospective controlled study, Morgan et al 2017; and two pre-post studies by deGroot et al, 2009 and Blouin et al. 2015) evidence that wheelchair propulsion training result in improved biomechanics of propulsion which are sustained over time.

There is level 1b (from one blinded RCT study by Rice et al. 2013; one RCT study by Rice et al. 2013; and one pre-post study by deGroot et al. 2009) evidence that using a multimedia approach results in improved wheelchair propulsion training outcomes.

There is level 2 evidence (from one cohort study by Kilkens et al. 2005; from one prospective controlled study by Torhaug et al. 2016; from three pre-post studyby deGroot et al. 2007; Rodgers et al. 2001; Dallmeijer et al. 2005) that exercise training at physical capacity and upper extremity strengthening influence wheelchair propulsion performance.

There is level 1b evidence (from one randomized control test study by van der Scheer et al. 2016) that twice weekly, low intensity wheelchair propulsion training is not adequate to affect fitness, however there is level 4 evidence (from one pre-post study; Qi et al. 2015) suggesting that manual wheelchair propulsion at low (1ms) and moderate (1.3ms) propulsion rates during typical daily life mobility activities contribute to cardiovascular conditioning.

There is level 2 evidence (from one randomized control study by Gauthier et al. 2018) evidence that community-based programs are feasible and safe training programs for manual wheelchair users.

There is level 5 evidence (from one observational study; Hatchett et al. 2009) that suggests that shoulder strength is a strong predictor for average daily distance propelled.

There is level 4 evidence (from one pre-post study; Karmarker et al. 2011 and two observational studies; Phang et al. 2012 and Tolerico et al. 2007) to suggest that 1) wheelchair use varies, particularly propulsion distances, 2) propulsion distance are environmentally dependent and 3) distances decrease with increasing age.

There is level 5 evidence (from two observational studies; Cooper et al. 2011 and Oyster et al. 2011) to suggest that of the cumulative time spent in a wheelchair over the course of a day, a small proportion is spent propelling distances, typically just over an hour a day.

There is level 4 evidence (from one case series study; Tsai et al. 2014) to suggest that the type of wheelchair used is not correlated with social participation.

There is level 5 evidence (from two observational studies by Pettersson et al. 2015 and Chaves et al. 2004) that suggests physical barriers and limitations in access, support and assistance negatively effect the use of power and manual wheelchairs in the community.

There is level 4 evidence (from one cohort study by Neslon et al. 2010) which suggests that tipping or falling from the wheelchair is the most frequently experienced wheelchair-use related accident.

There is level 4 evidence (from one cohort study by Nelson et al. (2010)) to suggest that there are a variety of predictive factors for wheelchair related falls and injuries including a recent increase in pain, recent history of falls, not using seat belts, lack of regular maintenance, the w/c not being professionally prescribed, high FIM scores on the motor subscale combined with a shorter w/c frame length and, a lack of accessibility at home entrance.

There is level 3 evidence (from one cohort study by Worobey et al. 2012, one case series study by McClure et al. 2009) to suggest that in a six month time period between one quarter and one half of wheelchairs will require a repair and that of these repairs up to one third will result in an adverse effect.

There is level 5 evidence (from five observational studies by Amosun et al. 2016; de Groot et al 2011; Rushton et al. 2012; Fitzgerald et al. 2005; Chan & Chan, 2007) that satisfaction with wheelchair use is moderate to high for people with spinal cord injury who use wheelchairs.

There is level 5 evidence (from  two observational studies by de Groot et al 2011; Fitzgerald et al. 2005) that satisfaction with wheelchair-related service delivery is lower than satisfaction with wheelchair use, primarily due to the slowness of the process, and less so with regards to repairs/service, professional services and follow up services.

There is level 5 evidence (from two observational studies by, Rushton et al. 2012; Chan & Chan, 2007) suggesting that wheelchair satisfaction is more highly focused on quality of life variables such as participation in leisure activities.

There is level 5 evidence (form one observational study by Gil-Agudo et al. 2013) suggesting there are differences in satisfaction across a number of variables for manual wheelchair models based on personal preferences.

There is level 1b evidence (from five RCT studies by Kirby et al., 2016; Ozturk et al. 2011; Routhier et al. 2012; Worobey et al., 2016; Yeo et al., 2018) that manual wheelchair skills training causes an immediate improvement in wheelchair skills.

There is level 2 evidence (from one RCT study by Wang et al. 2015) that video feedback during training produced similar results as conventional training.

There is level 1b evidence (from two randomized control studies by Routhier et al. 2012 and Kirby et al. 2018) that vary regarding how well skills learned are retained.

There is level 2 evidence (from one randomized control study by Lalumiere et al. 2018) that when learning to perform wheelies improvements in postural stability are noted when the rolling resistance is increased.

There is level 5 evidence (from one observational study; Hunt et al. 2004) that to meet full mobility needs, a wide variety of mobility devices are often used in conjunction with power wheelchairs.

There is level 5 evidence (from two observational studies; Sonenblum et al. 2008; Cooper et al. 2002) that there are no typical patterns of power wheelchair use in daily life but small bouts of movement or short distances at high speeds were more frequent.

There is level 5 evidence (from one observation study; Daveler et al. 2015) to suggest that there are people who drive power wheelchairs experience daily driving challenges such as door thresholds, and frequently encountered driving situations such as uneven terrain, curb cuts, gravel, and mud.

There is level 5 evidence (three observational studies, Sonenblum et al. 2009, Sonenblum & Sprigle, 2011a and Sonenblum & Sprigle 2011b) suggesting that on a daily basis, power positioning devices are used for a variety of reasons but predominantly in the small ranges of amplitude, and with great variability of frequency and duration.

There is level 2 evidence (from one prospective controlled trial and one pre-post study; Hobson & Tooms 1992; Mao et al. 2006) that the typical SCI seated posture has spinal and pelvic changes/abnormalities.

There is level 2 evidence (from two prospective controlled studies; Hobson 1992; Shields & Cook 1992) that in sitting postures typically assumed by people with SCI, maximum sitting pressures are higher than in able-bodied people.

There is level 4 evidence (from one pre-post study; Mao et al. 2006) that use of lateral trunk supports in specialized seating improve spinal alignment, reduce lumbar angles and reduce muscular effort for postural control.

There is level 2 evidence (from one prospective controlled trial; Shields & Cook 1992) that the use of lumbar supports does not affect buttock pressure.

There is level 3 evidence (from one case control study; Janssen-Potten et al. 2001) that there is no difference in balance and postural muscle control between static positions on a level surface and a 10° forward incline for people with SCI; the pelvic position does not change as compared to able-bodied participants.

There is level 3 evidence (from three repeated measures studies and one case control study; May et al. 2004; Hastings et al. 2003; Sprigle et al. 2003; Janssen-Potten et al. 2002) to support the evaluation of functional performance to facilitate the decision making process for assessment and prescription of wheelchair and seating equipment options providing objective information about performance.

There is level 4 evidence (from one post-test study; Gabison et al. 2017) to suggest that reaching does not consistently provide offloading at the ischial tuberosities and not equaly between left and right.

There is level 2 evidence (from one prospective controlled trial and one case control study; Kamper et al. 1999; Janssen-Potten et al. 2000) to support that pelvic positioning especially related to pelvic tilt and the relationship between the pelvis on the trunk, affects upper extremity and reaching activities, performance of activities of daily living and postural stability.

There is level 2 evidence (three randomized controlled trials; Gil-Agudo et al. 2009; Crane et al. 2016, Sonenblum et al. 2018a and from one pre-post study; Vilchis-Aranguren et al. 2015) suggesting that cushions that envelope specific to the individual’s shape may have lower sitting surface pressures  may have higher patient satisfaction than cushions that envelope less.

There is level 2 evidence (from one prospective controlled trial Burns & Betz 1999 and one randomized control study, Sonenblum et al. 2018a and one cohort study, Makhsous et al. 2007) that cushions that reduce the pressure (e.g., dynamic versus static) or offload pressure in the ischial tuberosity region may be associated with potentially beneficial reduction in seating interface pressure and/or pressure injury risk factors.

There is level 4 evidence (one pre-post test study by Sonenblum et al. (2018b) to suggest that the factors of body mass index, smoking status and pressure injury history effect tissue response to different loads when seated on a cushion.

There is level 2 evidence (from two prospective controlled trials Brienza & Karg 1998; Li et al. 2014, one post-test study by ;; Sprigle et al. 1990a; and one pre-post test study by Sprigle et al. 1990b;) to support that custom contoured cushions (CCC) have attributes that redistribute interface pressure better in comparison to other foam and/or flat foam cushions. However, disadvantages and cautions are identified for the day to day use of CCC.

There is level 4 evidence (from one post-test; Kernozek & Lewin 1998) to support that dynamic peak pressures are greater than static, but the cumulative loading is comparable between dynamic and static loading.

There is level 2 evidence (from one prospective controlled trial; Tam et al. 2003) to support that peak pressures are located slightly anterior to the ischial tuberosities (IT).

There is level 4 evidence (from one pre-post study; Stinson et al. 2013) to support the use and incorporation of forward reaching into daily activities as a means to promote pressure redistribution, provided the reach distance is adequate for an effective weight shift.

There is level 2 evidence (from one prospective control trial, one case control study, two pre-post study and three case series studies; Hobson 1992; Makhsous et al. 2007a; Sonenblum et al. 2014; Wu and Bogie, 2014; Smit et al. 2013; Coggrave & Rose 2003; Hendersen et al. 1994) to support position changes to temporarily redistribute interface pressure at the ischial tuberosities (IT) and sacrum by leaning forward greater than 45° or to the side greater than 15°.

There is level 4 evidence (from one case series study by Coggrave & Rose 2003; and two Pre-Post test studies by Smit et al. 2013; Hendersen et al. 1994) to support that a minimum two minute duration of forward leaning, side leaning or push-up must be sustained to raise tissue oxygen to unloaded levels.

There is level 3 evidence (from one case control study, two pre-post studies and one case series study; Makhsous et al. 2007a; Lin et al. 2014; Smit et al. 2013; Coggrave & Rose 2003) to support limiting the use of push-ups as a means for unweighting the sitting surface for pressure management.

There is level 4 evidence (one pre-post study Makhsous et al. 2007, one pre-post test study Maurer & Sprigle, 2004) to suggest the back support plays an important role in supporting the pelvis thereby increasing the area for pressure redistribution through the inclusion of the back surface.

There is level 4 evidence (one pre-post study and one pre-post test study; Makhsous et al. 2007; Maurer & Sprigle 2004) that sitting surface interface pressure decreases at the posterior aspect of the buttock as it is un-weighted however there is an increase in total force on the seat.

There is level 4 evidence (one post-test, Hobson 1992) to suggest that back support recline to 120° decreases average maximum pressure in the ischial tuberosity area but also causes the greatest ischial tuberosity shift (up to 6 cm) and a 25% increase in tangentially induced shear forces.

There is level 2 evidence (one randomized control test study by Sonenblum & Sprigle 2011c, one pre-post test study by Giesbrecht et al. 2011, one post-test Hobson 1992, two  pre-post test studies Henderson 1994 and  Spijkerman 1995 ) suggesting that there is an inverse relationship between tilt angle and pressure at the sitting surface and that significant reductions in interface pressure begins around 30° of tilt with maximum tilt providing maximum reduction of interface pressures. The amount of reduction realized was variable by person.

There is level 2 evidence (from three RCT Jan et al. 2010; Jan et al. 2013a; Jan & Crane 2013) to suggest that larger amounts of tilt alone or 15° tilt and greater in combination with 100° or 120° recline result in increased blood flow and decreased interface pressure at the ischial tuberosities (IT). There is inconsistency in the minimum amount of tilt needed to significantly increase both blood flow and interface pressure reduction. There is also limited evidence related to impact of shear forces with use of recline.

There is level 2 evidence (from two RCT studies Jan et al. 2013b; Sonenblum & Sprigle 2011c) to suggest that it cannot be assumed that changes in interface pressure through use of recline and/or tilt equates to an increase in blood flow at the IT or the sacrum.

There is level 2 evidence (from two RCT studies Jan et al. 2013b; Sonenblum & Sprigle 2011c) to suggest that muscle perfusion requires greater amplitudes of body position changes than that required for skin perfusion.

There is level 4 evidence (from one pre-post study; Lung et al. 2014) to suggest that peak pressure index, which is a common metric used in interface pressure mapping, displaces up to almost 7 cm during tilt and/or recline, therefore consideration for the size of the sensel window used to capture this data should either be large enough (7×7) or the location adjusted to ensure the data is fully captured.

There is level 2 evidence (one prospective controlled trial study by Inskip et al. 2017) that for people who sustained an autonomically complete SCI, that movement into a standing position for periods of time can make them vulnerable to severe orthostatic decreases in blood pressure.

There is level 5 evidence (from three observational studies; Di Marco et al. 2003; Taylor et al. 2015 and Ekiz et al. 2014) to suggest that there are differences in the wheelchair provision process between service providers

There is level 5 evidence (from two observational studies; Groah et al. 2014 and Ambrosio et al. 2007) to suggest that diagnosis and funding is associated with the type of wheeled mobility received.

There is level 5 evidence (from one observational study; Di Marco et al. 2003) that suggests there is a benefit to following a standard process for wheelchair provision.

There is level 4 evidence (from one case series study; Kennedy et al. 2003, one pre-post study; Samuelsson et al. 2001 and one observational study; Taylor et al. 2015) to suggest that people who receive a specialized seating assessment and client centred interventions may experience better outcomes.