Stakeholder Perspectives on Telehealth Effectiveness, Facilitators, and Barriers for Wheelchair Service Provision: A Needs Analysis

Rachel Taylor; Richard Schein; Corey Morrow

doi:10.63144/ijt.2025.6682

Authors

Rachel Taylor 1Department of Occupational Therapy, East Carolina University, Greenville, North Carolina, USA https://orcid.org/0000-0002-1674-3509
Richard Schein 2Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA https://orcid.org/0000-0002-9059-9672
Corey Morrow 3Division of Occupational Therapy, Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, South Carolina, USA https://orcid.org/0000-0002-3444-0421

DOI:

https://doi.org/10.63144/ijt.2025.6682

Keywords:

Mobility, Telehealth, Telerehabilitation, Wheelchair services

Abstract

Mobility impairments limit access to wheelchair services, especially in rural settings. Telehealth offers one potential solution to improve access. The purpose of this paper is to describe the current perceptions of telehealth wheelchair follow-up services among a select group working in the industry. A 35-question survey was completed by 32 stakeholders in the wheelchair industry to describe their perceptions of telehealth effectiveness, facilitators, and barriers for wheelchair provision and follow-up. Telehealth was generally perceived as effective for reaching rural populations, but specific subpopulations and technology requirements should also be considered. Respondents also indicated which Common Procedural Terminology (CPT) billing codes are commonly used for wheelchair services. The results of this survey will be used to design a quality improvement project within a rural healthcare system. This project will aim to improve access to wheelchair follow-up services via telehealth that are feasible and sustainable for the local healthcare system.

References

American Occupational Therapy Association. (2018). Telehealth in occupational therapy. The American Journal of Occupational Therapy, 72(Supplement_2), 7212410059. https://doi.org/10.5014/ajot.2018.72S219 DOI: https://doi.org/10.5014/ajot.2018.72S219

American Telemedicine Association. (2020). Telehealth: Defining 21st Century Care

Bell, M., Schein, R. M., Straatmann, J., Dicianno, B. E., & Schmeler, M. R. (2020). Functional mobility outcomes in telehealth and in-person assessments for wheeled mobility devices. International Journal of Telerehabilitation, 12(2), 27–34. https://doi.org/10.5195/ijt.2020.6335 DOI: https://doi.org/10.5195/ijt.2020.6335

Betz, M., DiGiovine, C. P., Galbreath, P., Stojkov, A., Berner, T., Hibbs, R., & Schein, R. M. (2022). Service delivery for complex rehabilitation technology: A scoping review. Disability and Rehabilitation: Assistive Technology, 17(8), 853–871. https://doi.org/10.1080/17483107.2022.2111609 DOI: https://doi.org/10.1080/17483107.2022.2111609

Brown, S. (2010). Likert scale examples for surveys. Iowa State University Extension. https://www.extension.iastate.edu/documents/anr/likertscaleexamplesforsurveys.pdf

Centers for Disease Control and Prevention. (2023, May). Disability and Health Data System (DHDS). http://dhds.cdc.gov. Retrieved May 15, 2023, from http://dhds.cdc.gov

Centers for Medicare & Medicaid Services. (2023). Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2024. Federal Register. https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-federal-regulation-notices/cms-1784-f

Cortelyou-Ward, K., Atkins, D. N., Noblin, A., Rotarius, T., White, P., & Carey, C. (2020). Navigating the digital divide: Barriers to telehealth in rural areas. Journal of Health Care for the Poor and Underserved, 31(4), 1546–1556. DOI: https://doi.org/10.1353/hpu.2020.0116

Dahl-Popolizio, S., Carpenter, H., Coronado, M., Popolizio, N. J., & Swanson, C. (2020). Telehealth for the provision of occupational therapy: Reflections on experiences during the COVID-19 pandemic. International Journal of Telerehabilitation, 12(2), 77–92. https://doi.org/10.5195/ijt.2020.6328 DOI: https://doi.org/10.5195/ijt.2020.6328

Davis, J. C., Bryan, S., Best, J. R., Li, L. C., Hsu, C. L., Gomez, C., Vertes, K. A., & Liu-Ambrose, T. (2015). Mobility predicts change in older adults' health-related quality of life: Evidence from a Vancouver falls prevention prospective cohort study. Health and Quality of Life Outcomes, 13(1), 101. https://doi.org/10.1186/s12955-015-0299-0 DOI: https://doi.org/10.1186/s12955-015-0299-0

Federal Communications Commission. (2020). 2020 Broadband Deployment Report. https://docs.fcc.gov/public/attachments/FCC-20-50A1.pdf

Gasque, H., Morrow, C., Grattan, E., & Woodbury, M. (2024). Understanding occupational therapists’ knowledge and confidence when assessing for spatial neglect: A special issue review. The American Journal of Occupational Therapy, 78(2). https://doi.org/10.5014/ajot.2024.050354 DOI: https://doi.org/10.5014/ajot.2024.050354

Ghaljaie, F., Naderifar, M., & Goli, H. (2017). Snowball sampling: A purposeful method of sampling in qualitative research. Strides in Development of Medical Education, 14(3). https://doi.org/10.5812/sdme.67670 DOI: https://doi.org/10.5812/sdme.67670

Graham, F., Boland, P., Grainger, R., & Wallace, S. (2020). Telehealth delivery of remote assessment of wheelchair and seating needs for adults and children: A scoping review. Disability and Rehabilitation, 42(24), 3538–3548. https://doi.org/10.1080/09638288.2019.1595180 DOI: https://doi.org/10.1080/09638288.2019.1595180

Hahn, Z., Hotchkiss, J., Atwood, C., Smith, C., Totten, A., Boudreau, E., Folmer, R., Chilakamarri, P., Whooley, M., & Sarmiento, K. (2023). Travel burden as a measure of healthcare access and the impact of telehealth within the Veterans Health Administration. Journal of General Internal Medicine, 38(Suppl 3), 805–813. https://doi.org/10.1007/s11606-023-08125-3 DOI: https://doi.org/10.1007/s11606-023-08125-3

Hansen, R., Tresse, S., & Gunnarsson, R. K. (2004). Fewer accidents and better maintenance with active wheelchair check-ups: A randomized controlled clinical trial. Clinical Rehabilitation, 18(6), 631–639. https://doi.org/10.1191/0269215504cr777oa DOI: https://doi.org/10.1191/0269215504cr777oa

Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O'Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., Duda, S. N., & REDCap Consortium. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208 DOI: https://doi.org/10.1016/j.jbi.2019.103208

Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010

Henderson, G. V., Boninger, M. L., Dicianno, B. E., & Worobey, L. A. (2022). Type and frequency of wheelchair repairs and resulting adverse consequences among veteran wheelchair users. Disability and Rehabilitation: Assistive Technology, 17(3), 331–337. https://doi.org/10.1080/17483107.2020.1785559 DOI: https://doi.org/10.1080/17483107.2020.1785559

James, A. M., Pramana, G., Schein, R. M., Mhatre, A., Pearlman, J., Macpherson, M., & Schmeler, M. R. (2023). A descriptive analysis of wheelchair repair registry data. Assistive Technology, 35(4), 312–320. https://doi.org/10.1080/10400435.2022.2044407 DOI: https://doi.org/10.1080/10400435.2022.2044407

Keisler-Starkey, K., Bunch, L. N., & Lindstrom, R. A. (2023). Health Insurance Coverage in the United States: 2022. U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2023/demo/p60-281.pdf

Lagu, T., Hannon, N. S., Rothberg, M. B., Wells, A. S., Green, K. L., Windom, M. O., Dempsey, K. R., Pekow, P. S., Avrunin, J. S., Chen, A., & Lindenauer, P. K. (2013). Access to subspecialty care for patients with mobility impairment: A survey. Annals of Internal Medicine, 158(6), 441–446. https://doi.org/10.7326/0003-4819-158-6-201303190-00003 DOI: https://doi.org/10.7326/0003-4819-158-6-201303190-00003

Lee, E. C., Grigorescu, V., Enogieru, I., Smith, S. R., Samson, W., Conmy, A. B., & De Lew, N. (2023). Updated National Survey Trends in Telehealth Utilization and Modality (2021-2022)

Lillicrap, L., Hunter, C., & Goldswain, P. (2021). Improving geriatric care and reducing hospitalisations in regional and remote areas: The benefits of telehealth. Journal of Telemedicine and Telecare, 27(7), 397–408. https://doi.org/10.1177/1357633X19881588 DOI: https://doi.org/10.1177/1357633X19881588

Lyu, M., Zhao, Q., Yang, Y., Hao, X., Qin, Y., & Li, K. (2022). Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review. Australian Journal of Rural Health, 30(4), 442–457. DOI: https://doi.org/10.1111/ajr.12869

Malagodi, M., Schmeler, M. R., Shapcott, N. G., & Pelleschi, T. (1998). The use of telemedicine in assistive technology service delivery: Results of a pilot study. Technology Special Interest Section Quarterly, 8(1), 1–4.

McClammer, C., Choma, E. A., Schein, R. M., Schmeler, M. R., Pramana, G., Gliniak, J., & Morrow, C. (2024). Telerehabilitation for new wheelchair evaluations: A retrospective study of patient characteristics. International Journal of Telerehabilitation, 16(1). https://doi.org/10.5195/ijt.2024.6630 DOI: https://doi.org/10.5195/ijt.2024.6630

Morrow, C., Woodbury, M. L., & Simpson, K. (2024). Outpatient treatment approach differences for stroke survivors in rural, nonrural, & socially disadvantaged communities: A retrospective analysis. The American Journal of Occupational Therapy, 78(S2), 7811500206–7811500206p1. https://doi.org/10.5014/ajot.2024.78S2-PO206 DOI: https://doi.org/10.5014/ajot.2024.78S2-PO206

Morrow, C., Woodbury, M., Simpson, A. N., Almallouhi, E., & Simpson, K. N. (2023). Determining the marginal cost differences of a telehealth versus an in-person occcupational therapy evaluation session for stroke survivors using time-driven activity-based costing. Archives of Physical Medicine and Rehabilitation, 104(4), 547–553. https://doi.org/10.1016/j.apmr.2022.11.006 DOI: https://doi.org/10.1016/j.apmr.2022.11.006

Mullens, C. L., Lussiez, A., Scott, J. W., Kunnath, N., Dimick, J. B., & Ibrahim, A. M. (2023). High-risk surgery among Medicare beneficiaries living in health professional shortage areas. The Journal of Rural Health, 39(4), 824–832. https://doi.org/10.1111/jrh.12748 DOI: https://doi.org/10.1111/jrh.12748

Murimwa, G. Z., Meier, J., Nehrubabu, M., Zeh, H. J., Yopp, A. C., & Polanco, P. M. (2023). Implications of the interaction between travel burden and area deprivation for patients with pancreatic cancer. The American Journal of Surgery, 226(4), 515–522. https://doi.org/10.1016/j.amjsurg.2023.06.013 DOI: https://doi.org/10.1016/j.amjsurg.2023.06.013

Musich, S., Wang, S. S., Ruiz, J., Hawkins, K., & Wicker, E. (2018). The impact of mobility limitations on health outcomes among older adults. Geriatric Nursing (New York, N.Y.), 39(2), 162–169. https://doi.org/10.1016/j.gerinurse.2017.08.002 DOI: https://doi.org/10.1016/j.gerinurse.2017.08.002

Ott, K. K., Schein, R. M., Straatmann, J., Schmeler, M. R., & Dicianno, B. E. (2022). Development of a home-based telerehabilitation service delivery protocol for wheelchair seating and mobility within the Veterans Health Administration. Military Medicine, 187(5-6), E718–E725. https://doi.org/10.1093/milmed/usab091 DOI: https://doi.org/10.1093/milmed/usab091

RESNA. (2011). RESNA Wheelchair Service Provision Guide. https://www.resna.org/Portals/0/Documents/Position%20Papers/RESNAWheelchairServiceProvisionGuide.pdf

Richmond, T., Peterson, C., Cason, J., Billings, M., Terrell, E. A., Lee, A. C. W., Towey, M., Parmanto, B., Saptono, A., Cohn, E. R., & Brennan, D. (2017). American Telemedicine Association's principles for delivering telerehabilitation services. International Journal of Telerehabilitation, 9(2), 63–68. https://doi.org/10.5195/ijt.2017.6232 DOI: https://doi.org/10.5195/ijt.2017.6232

Rousseau-Harrison, K., & Rochette, A. (2013). Impacts of wheelchair acquisition on children from a person-occupation-environment interactional perspective. Disability and Rehabilitation: Assistive Technology, 8(1), 1–10. https://doi.org/10.3109/17483107.2012.670867 DOI: https://doi.org/10.3109/17483107.2012.670867

Ruffing, J. J., Schmeler, M. R., Schein, R. M., & Mhatre, A. (2024). A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services. Disability and Rehabilitation: Assistive Technology, ahead-of-print(-), 1–6. https://doi.org/10.1080/17483107.2022.2121007 DOI: https://doi.org/10.1080/17483107.2022.2121007

Schein, R. M., Yang, A., McKernan, G. P., Mesoros, M., Pramana, G., Schmeler, M. R., & Dicianno, B. E. (2021). Effect of the Assistive Technology Professional on the provision of mobility assistive equipment. Archives of Physical Medicine and Rehabilitation, 102(10), 1895–1901. https://doi.org/10.1016/j.apmr.2021.03.024 DOI: https://doi.org/10.1016/j.apmr.2021.03.024

Schein, R. M., Schmeler, M. R., Holm, M. B., Saptono, A., & Brienza, D. (2010). Telerehabilitation wheeled mobility and seating assessments compared with in person. Archives of Physical Medicine and Rehabilitation, 91(6), 874–878. https://doi.org/10.1016/j.apmr.2010.01.017 DOI: https://doi.org/10.1016/j.apmr.2010.01.017

Shachar, C., Engel, J., & Elwyn, G. (2020). Implications for telehealth in a postpandemic future: Regulatory and privacy issues. Jama, 323(23), 2375–2376. DOI: https://doi.org/10.1001/jama.2020.7943

U.S. Census Bureau, & U.S. Department of Commerce. (2023). Age by Disability Status by Health Insurance Coverage Status. https://data.census.gov/table/ACSDT1Y2023.B18135?q=B18135

Wee, J., & Lysaght, R. (2009). Factors affecting measures of activities and participation in persons with mobility impairment. Disability and Rehabilitation, 31(20), 1633–1642. https://doi.org/10.1080/09638280902736346 DOI: https://doi.org/10.1080/09638280902736346

Williams, E. M., Ortiz, K., Zhang, J., Zhou, J., & Kamen, D. (2016). The systemic lupus erythematosus travel burden survey: Baseline data among a South Carolina cohort. BMC Research Notes, 9(252), 246. https://doi.org/10.1186/s13104-016-2060-0 DOI: https://doi.org/10.1186/s13104-016-2060-0

Winters, J. M. (2002). Telerehabilitation Research: Emerging Opportunities. Annual Review of Biomedical Engineering, 4(1), 287–320. https://doi.org/10.1146/annurev.bioeng.4.112801.121923 DOI: https://doi.org/10.1146/annurev.bioeng.4.112801.121923

Stakeholder Perspectives on Telehealth Effectiveness, Facilitators, and Barriers for Wheelchair Service Provision: A Needs Analysis

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