Abstract:

Objective To develop a systematic and scientific assessment-adaptation-evaluation framework for wheelchair cushions.

Methods A mixed-methods approach integrating literature review, qualitative interviews and Delphi expert consultation was employed. First, 27 relevant studies were identified through systematic literature searches, comprehensively synthesizing wheelchair cushion types, performance indicators, key assessment/adaptation elements and evaluation methods. Second, semi-structured interviews were conducted with 24 wheelchair users and six assistive technology specialists. Interview transcripts were analyzed using Colaizzi's phenomenological analysis to extract themes and deeply explore user needs and practitioner experiences. Based on the literature and interview findings, the research team developed a preliminary protocol comprising an assessment form, an adaptation process table and an effectiveness evaluation form. Finally, 20 multidisciplinary experts participated in a two-round Delphi consultation. Experts rated the importance of items using a 5-point Likert scale. Consensus was analyzed using Kendall's W coefficient and the coefficient of variation (CV), supplemented by mean importance scores and full-score frequency to refine the protocol.

Results The consultation demonstrated excellent expert engagement (100% response rate) and strong authority (Cr = 0.90). The finalized protocol comprised of an assessment form (four primary domains/21 secondary items), an adaptation protocol (two primary domains/eight secondary items) and an evaluation form (two primary domains/15 secondary items). Statistical analysis revealed Kendall's W = 0.20 (P < 0.05), mean importance scores of (4.48±0.72), CV = (0.15±0.05), and full-score frequency of (60.80±16.39)%, indicating acceptable consensus.

Conclusion The assessment-adaptation-evaluation method for wheelchair cushions constructed in this study is scientific, comprehensive and operable, and can provide a standardized tool for clinical personalized adaptation. Future studies should enhance the applicability of the method in diverse clinical settings.

Key words: wheelchair cushion, pressure injury, assessment-adaptation-evaluation