Development of the RightWheel manual wheelchair wheel rolling resistance clinical decision support system through iterative clinician interviews.

Introduction: Manual wheelchair users (MWU) frequently experience upper limb (UL) injury and pain. Clinical practice guidelines (CPG) provide guidance on how to reduce risk of UL injury and pain but the recommendations provide only general advice such as to minimizing repetitive strain by reducing rolling resistance (RR). RR is due to energy loss between wheels and ground during wheelchair propulsion and is a major contributor of repetitive strain for MWUs. Motivated by the recommendation to reduce RR, we developed a clinical decision support system (CDSS) to provide client-specific RR predictions across several wheelchair setups to allow clinicians and users to make informed decisions.

Methods: An iterative user-centered design process (mixed methods) recruited ATP certified occupational or physical therapists to suggest modifications, assess usability and usefulness, identify client use cases, and provide rear wheel and caster selection criteria.

Results: Six clinicians participated and suggested over 100 modifications. Usability (SUS = 83.8; modified QUIS = 7.5) and perceived usefulness (TAQ = 4.7) were acceptable. Client use cases and rear wheel and caster selection criteria were identified. All clinicians thought it would be a useful tool.

Conclusions: RightWheel online CDSS provides user-customized RR estimates for equipment options in an easy-to-understand format, and was deemed ready for pilot launch.