The impact of power assist devices on manual wheelchair use across international classification of functioning, disability and health framework categories and the implications for insurance policy coverage: A scoping review

Power assist systems (PAS) on manual wheelchairs (MWC) aim to enable functional mobility and support the health of MWC users; however, current Medicare policy prohibits obtaining a PAS prior to one year of MWC use. Clinically, the authors have observed that when people needing a wheelchair have difficulty propelling at times in an MWC, they are likely to pursue a power wheelchair since PAS is not an option in the first year of use. Therefore, this scoping review aimed to explore the evidence related to PAS use through the lens of the International Classification of Functioning, Disability and Health framework. A total of 790 titles and abstracts were reviewed, with 26 articles included addressing mobility (n = 24), neuromuscular and movement (n = 10), cardiovascular and respiratory (n = 8), general tasks (n = 10), pain (n = 2) and mental functions (n = 2). Types of PAS represented included power assist push-rims (n = 23), rear-drive PAS (n = 4), and front-attached PAS (n = 1). Quantitative designs accounted for 23 studies, with 15 experimental designs. Overall, results positively supported the use of PAS across all environments, revealing reduced burden with propelling with proper training and support. The evidence did not support previous MWC experience as a factor in the user’s ability to effectively use PAS.