Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, Brazil.
Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Disabil Rehabil Assist Technol. 2023 Oct;18(7):1163-1174. doi: 10.1080/17483107.2021.1993360. Epub 2021 Nov 9.
The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations.
This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. The protocol for this systematic review was registered with PROSPERO International Prospective Register of Systematic reviews. The following PICOS eligibility criteria were considered: (P) Population was individuals with mobility limitations that live in their community (e.g., non-institutionalized), with aged 18 or older; (I) Intervention was mobility assistive technologies (MAT), such as manual and powered wheelchairs; (C) Comparators (Not Applied); (O) Outcome, the primary outcome of interest, was established as the cost-effectiveness of wheelchair interventions. Direct and indirect costs per unit of effect were expressed in terms of clinical outcome units, quality-adjusted life years gained, utility scores, quality of life measures and incremental cost-effectiveness ratios to inform the economic outcomes. (S) Study design was considered as a health economic evaluation (i.e., including cost-effectiveness analysis, cost-utility analysis and cost benefit analysis as well as partial economic evaluations). The Consolidated Health Economic Evaluation Reporting Standards - CHEERS, checklist was used for summarising and interpreting the results of economic evaluations.
Sixteen studies were included, two were identified as full health economic evaluations and 14 were considered partial health economic evaluations.
Only two full health economic analyses of wheelchair interventions have been conducted and both focussed on powered wheelchair provision. There are important gaps in current knowledge regarding wheelchair health economic methods and available outcome measures, which there is a great need for further research.Implication for RehabilitationSystematic reviews of health economic evaluation studies are useful for synthesising economic evidence about health interventions and provide insight in new research development.Organisations involved in the provision of wheelchairs should apply cost-effectiveness outcome measures to help raise the standard of provision, to support evidence-based practice, and to improve resource utilisation.
本系统评价的总体目标是确定和综合有关成人移动障碍者轮椅干预措施的有效性、资源利用和成本的最佳现有证据。
本系统评价是根据考科蓝中心的指南进行的。本系统评价的方案已在 PROSPERO 国际前瞻性系统评价注册库中注册。考虑了以下 PICOS 纳入标准：（P）人群为居住在社区（例如非机构化）的有移动障碍的个体，年龄在 18 岁或以上；（I）干预措施为移动辅助技术（MAT），如手动和动力轮椅；（C）对照（不适用）；（O）结局，主要关注的结局是轮椅干预措施的成本效益。每单位效果的直接和间接成本以临床结局单位、获得的质量调整生命年、效用评分、生活质量衡量标准和增量成本效益比表示，以告知经济结果。（S）研究设计被认为是健康经济评估（即包括成本效益分析、成本效用分析和成本效益分析以及部分经济评估）。使用统一的健康经济评估报告标准 - CHEERS 清单总结和解释经济评估的结果。
纳入了 16 项研究，其中 2 项被确定为完整的健康经济评估，14 项被认为是部分健康经济评估。
只有两项关于轮椅干预措施的全健康经济分析，并且都集中在动力轮椅的供应上。关于轮椅健康经济方法和现有结果衡量标准的现有知识存在重要差距，因此非常需要进一步研究。
健康经济评价研究的系统评价对于综合有关健康干预措施的经济证据非常有用，并为新的研究进展提供了深入的了解。
参与轮椅提供的组织应应用成本效益结果衡量标准，以帮助提高提供标准，支持基于证据的实践，并改善资源利用。
