Implications of a Wheelchair-integrated Transfer System for Patient Safety, Caregiver Ergonomics, and Health Service Delivery in Low-resource Settings

Implications of a Wheelchair-integrated Transfer System for Patient Safety, Caregiver Ergonomics, and Health Service Delivery in Low-resource Settings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implications of a Wheelchair-integrated Transfer System for Patient Safety, Caregiver Ergonomics, and Health Service Delivery in Low-resource Settings Eladio Quintana, César Yegros This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8833775/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Patient transfers involving individuals with reduced mobility constitute a frequent activity within health services and represent a critical point in terms of patient safety, caregiver ergonomic load, and operational efficiency. Transfers from wheelchair to vehicle are particularly challenging, especially in low-resource settings, where the availability of assistive technologies is limited and transfers are usually performed using manual techniques. This study analyzes, from a health services research perspective, the implications of a wheelchair-integrated transfer system on care processes. [ 9 ] An observational pilot evaluation was carried out during supervised wheelchair-to-vehicle transfers, focusing on aspects related to patient stability, caregiver physical effort, process predictability, and integration into routine workflows. The observations suggest that the system allowed more controlled and standardized transfers, reducing manual handling and caregiver physical effort, and improving patient stability and participation. From an organizational perspective, the system showed potential to contribute to safer and more efficient transfer processes, with relevant implications for the sustainability of health services in resource-limited contexts. Although this is an exploratory study, the findings support the need to continue evaluating integrated assistive technologies not only for their technical performance, but also for their impact on the organization and functioning of health services. Biomedical Engineering Physical Medicine & Rehab Health Policy Health services research Patient transfer Assistive technology Caregiver ergonomics Patient safety Wheelchair users Low-resource healthcare settings Introduction Patient transfer is an activity inherent to the provision of health services and is present in practically all levels of care, from outpatient care to hospitalization and discharge processes. In the case of people with reduced mobility, these tasks acquire particular relevance, since they depend on wheelchairs or other assistive devices to perform transitions between different environments, surfaces, and means of transportation. Despite their routine nature, transfers represent one of the moments of greatest vulnerability for both patients and caregivers. Patient transfers involve a complex interaction between the user, the caregiver, and the physical environment. Factors such as the height difference between surfaces, the space available for maneuvering, the patient’s body weight, the level of collaboration during the transfer, and the caregiver’s experience directly influence the safety and effectiveness of the process. When these factors are not adequately managed, the likelihood of instability, falls, abrupt movements, and adverse events during the transfer increases. From the caregiver’s perspective, manual transfer tasks represent one of the main sources of physical workload within the healthcare setting. Numerous studies have documented the association between manual patient transfers and the occurrence of musculoskeletal injuries, particularly in the lumbar region, shoulders, and upper limbs. These injuries not only affect the health and well-being of healthcare personnel and informal caregivers, but also have relevant organizational consequences, such as work absenteeism, reduced operational capacity, and increased costs associated with care. [ 3 – 5 ] Wheelchair-to-vehicle transfers constitute a particularly challenging scenario within the set of transfer activities. Unlike transfers performed in controlled clinical environments, transfers to vehicles must adapt to confined spaces, non-standardized surfaces, and significant differences in seat height. These conditions hinder proper patient positioning and force the caregiver to adopt awkward postures and apply force in a sustained or sudden manner, increasing ergonomic risk and the likelihood of incidents. In low-resource health systems, these difficulties are exacerbated by multiple structural factors. Staff shortages, high patient volumes, and limited availability of specialized equipment mean that transfers are frequently performed using manual techniques or basic aids that provide limited mechanical support. In many cases, caregivers must resort to improvised solutions that rely heavily on individual experience and physical strength, introducing high variability in the quality and safety of the transfer process. [ 2 , 8 ] Although assistive technologies designed to facilitate patient transfers exist, their adoption in low-resource settings is often limited by economic, logistical, and operational barriers. Many commercial devices require significant investments, structural modifications to vehicles or healthcare infrastructure, or present a level of complexity that hinders their integration into routine workflows. As a result, a gap persists between safe patient handling recommendations and actual transfer practices in numerous care contexts. [ 7 ] In this scenario, there is a need to explore solutions that allow improving transfer safety and caregiver ergonomics without introducing additional operational burden for health services. Wheelchair-integrated transfer systems represent a potentially relevant alternative, as they combine mobility and transfer assistance functions within a single device. By being directly integrated into the wheelchair, these systems have the potential to reduce dependence on external devices, facilitate motion control, and adapt to diverse care environments. The present study is situated within this framework and adopts a health services–oriented perspective to analyze the implications of a wheelchair-integrated transfer system. Beyond the technical evaluation of the device, the work focuses on understanding how this type of solution can influence patient safety, caregiver physical workload, and the organization of transfer processes within health services, particularly in contexts characterized by resource limitations. [ 3 – 5 ] Health Services Context Wheelchair users frequently require assistance to perform transitions between different care environments, including transfers from healthcare facilities to private or institutional vehicles, and vice versa. These transfers are part of the daily routine of numerous services, such as outpatient consultations, ambulatory rehabilitation, short-term hospitalizations, and hospital discharge processes. In institutions with high care volumes, the cumulative number of transfers can be considerable, magnifying the impact of inefficient or unsafe transfer practices. In public health systems serving large populations, especially in low- and middle-income countries, transfer tasks are carried out in a context of high demand and limited resources. Shortages of trained personnel, frequent caregiver turnover, and pressure to meet tight care schedules condition the way transfers are performed. In this setting, transfers often prioritize speed over ergonomics or process standardization, increasing variability and the risk associated with each maneuver. From an organizational perspective, these processes have implications that go beyond the specific moment of the transfer. Difficulties during transfers can generate delays in care, prolong discharge times, increase staff fatigue, and contribute to the occurrence of musculoskeletal injuries. When these effects are repeated systematically, they negatively impact operational efficiency and the sustainability of health services. In this context, interventions aimed at improving the safety and predictability of transfers acquire strategic value. Assistive technologies that allow reducing manual handling, standardizing the transfer process, and decreasing caregiver physical workload can contribute to improving not only individual patient outcomes, but also the overall performance of the healthcare system. The integration of these solutions into existing workflows is particularly relevant in low-resource settings, where adaptability and compatibility with available infrastructure are key determinants for implementation. Materials and Methods General description of the wheelchair-integrated transfer system The wheelchair-integrated transfer system analyzed in this study was conceived with the objective of facilitating safer and more controlled transfers between the wheelchair and the vehicle, without relying on external devices or requiring permanent modifications to the infrastructure or means of transportation. Unlike independent lifting systems, the design is integrated directly into the structure of the wheelchair, combining mobility and transfer assistance functions into a single device. From a functional perspective, the system incorporates a vertical seat lifting mechanism together with a controlled rotation movement. This combination allows precise alignment of the wheelchair seat with the vehicle seat, reducing height differences and the lateral distance that the patient must travel during the transfer. These variables have been repeatedly identified in the literature as critical factors influencing patient stability and caregiver physical workload during transfer maneuvers. The vertical adjustment of the seat makes it possible to compensate for height differences between the wheelchair and the vehicle, which may vary significantly depending on the type of transportation used. In real care contexts, this variability includes everything from private vehicles to institutional transport units, each with different access configurations and seat heights. The system’s ability to adapt to these conditions contributes to a more predictable transfer process and reduces the need for corrective maneuvers during the execution of the transfer. The controlled rotation movement of the seat allows the user to be oriented toward the interior or exterior of the vehicle in a progressive and stable manner. This aspect is particularly relevant during the initial and final phases of the transfer, moments in which the greatest risks of instability are concentrated. By facilitating precise alignment, the system reduces the need for wide lateral displacements, which usually require greater physical intervention by the caregiver. From the user’s point of view, the system is designed to allow active participation during the transfer, to the extent of the user’s functional capacities. The stability provided by the integrated mechanism favors the patient’s ability to collaborate in positioning and postural adjustment, which contributes both to safety and to the perception of control during the process. For the caregiver, this characteristic translates into a substantial change in role during the transfer, shifting from a function based on the application of physical force to a task focused on supervision and guidance of movement. A key aspect of the design is its compatibility with standard vehicles and common care environments. The system does not require special anchoring points, external lifting platforms, or structural modifications to vehicles, which facilitates its integration into existing workflows. [ 9 ] This characteristic is especially relevant in low-resource settings, where the availability of specialized infrastructure is limited and solutions must adapt to heterogeneous operational conditions. Although a detailed technical description of the mechanical design, actuation system, and materials used has been previously presented in an independent technical preprint, in the present study the system is analyzed from a service-oriented perspective. The emphasis is not placed on isolated mechanical performance, but on the way in which the device interacts with the user, the caregiver, and the care environment, and on how this interaction may influence safety, ergonomics, and the organization of transfer processes. [ 9 ] Pilot evaluation in a care context In order to explore the practical implications of the integrated transfer system in real care scenarios, an observational pilot evaluation was conducted. Given the health services–oriented focus of the study, the evaluation was designed to analyze the transfer process as a whole, rather than to generate quantitative clinical metrics or to validate the technical performance of the device under controlled laboratory conditions. The evaluation included the participation of adult volunteers from a hospital, both wheelchair users and participants without disabilities, who performed supervised wheelchair-to-vehicle transfers. The evaluation scenarios were hospital patient entry and exit areas, as well as ambulatory rehabilitation services and routine patient transport within the hospital, including reduced maneuvering spaces, variability in vehicle seat height, and the need for coordination between the user and the caregiver. [ 1 ] All transfers were performed under supervision and under controlled safety conditions. No invasive procedures were carried out, and all participants provided informed consent prior to participating in the evaluation. The evaluation design prioritized systematic observation of aspects related to safety, ergonomics, and usability, rather than the measurement of specific clinical outcomes. During each transfer scenario, structured observations were collected across multiple domains. These included patient stability during positioning and transfer, perceived safety throughout the maneuver, the physical effort required by the caregiver, posture adopted during the transfer, degree of control over the process, and the total time required to complete the transfer. Special attention was paid to the phases of the transfer that traditionally concentrate higher risk, such as initial seat alignment, lateral movement, and the initiation of the surface change. A central element of the evaluation was the analysis of the interaction between the integrated transfer system and the care environment. Rather than isolating the performance of the device, the evaluation focused on understanding how the presence of the system modified the transfer process, the dynamics between patient and caregiver, and the predictability of the task within the care workflow. This approach made it possible to identify practical advantages and limitations that are particularly relevant from the perspective of healthcare service delivery. Enriched data from the pilot evaluation During the pilot evaluation, the integrated transfer system was tested in multiple wheelchair-to-vehicle transfer scenarios, involving a total of 120 adult volunteers and different transport configurations. Transfers were performed in vehicles with seat heights ranging approximately between 50 and 80 cm, reflecting the usual variability found in patient transport contexts. Throughout the evaluation, approximately 160 lifting cycles were completed, with no structural failures, abnormal vibrations, or loss of system stability recorded. The time required for the vertical lifting phase during vehicle entry and exit maneuvers was approximately 7 seconds per cycle, while seat alignment and positioning required between 10 and 30 seconds, depending on the vehicle configuration and the specific conditions of each transfer. The integrated lifting and rotation mechanism made it possible to compensate for seat height differences of up to approximately 30 cm, reducing the lateral transfer distance within the range of 15 to 20 cm compared to conventional wheelchair-to-vehicle transfer methods. This reduction in lateral distance had a direct impact on the way the transfer was executed, decreasing the need for abrupt postural adjustments and facilitating a more continuous and controlled movement. Although the evaluation was not designed to generate quantitative clinical outcomes or formal statistical comparisons, the descriptive data obtained provide a relevant operational perspective. The repeatability of the lifting cycles, the consistency of execution times, and the absence of functional failures suggest adequate operational feasibility of the system in typical care scenarios. From a service-oriented perspective, these data acquire relevance when considered in relation to the accumulated volume of transfers performed in large institutions. The ability to complete critical transfer phases within predictable timeframes and with a high level of control may contribute to reducing process variability, a key factor for efficiency and planning in health services. Implications for patient safety Patient safety during transfer activities depends on multiple factors that interact simultaneously, including postural stability, movement control, process predictability, and coordination between the patient and the caregiver. Wheelchair-to-vehicle transfers represent a particularly sensitive scenario from this point of view, as they concentrate risk conditions associated with height differences, non-standardized surfaces, and limited maneuvering spaces. The observations made during the pilot evaluation indicated that the wheelchair-integrated transfer system contributed to a more stable and controlled transfer process, especially during the critical phases of seat alignment and lateral movement. By allowing progressive height adjustment and controlled seat rotation, the system reduced the need for abrupt movements and improvised adjustments, which are usually associated with loss of balance and incidents during transfers. A relevant aspect observed was the improvement in the predictability of the transfer process. The ability to anticipate each phase of the transfer and execute movements sequentially allowed better coordination between the patient and the caregiver. This predictability not only reduces the risk of adverse events, but also contributes to generating an environment perceived as safer by the user, which may positively influence behavior during the transfer. Likewise, the system promoted greater active participation of the patient in the transfer process. By providing a stable and controlled base, users were able to collaborate in positioning and postural adjustment according to their functional capacities. This active participation reduces the likelihood of unexpected movements and improves synchronization between patient and caregiver, factors that have been identified as key determinants of safety during transfers. Although the pilot evaluation did not include quantitative metrics of adverse event reduction, the observed improvements in stability, control, and predictability are consistent with established principles of safe patient handling. From this perspective, wheelchair-integrated transfer systems may contribute to creating safer transfer conditions, particularly in environments where technological alternatives are limited. Implications for caregiver ergonomics Manual patient transfer tasks constitute one of the main sources of physical workload and ergonomic risk for caregivers and healthcare personnel. Wheelchair-to-vehicle transfers, in particular, often require awkward postures, trunk flexion, sustained force application, and sudden movements, all of which are factors associated with an increased risk of musculoskeletal injuries. During the pilot evaluation, it was observed that the integrated transfer system significantly reduced the need for manual lifting by the caregiver. Instead of supporting the patient’s body weight or performing improvised lifting maneuvers, caregivers were able to guide the transfer movement through system control. This change in transfer dynamics represents a transition from a force-based approach to an assisted and controlled process. The reduction in lateral transfer distance and the ability to adjust seat height contributed to improved caregiver postural alignment during the maneuver. By minimizing the need for excessive trunk flexion and force application in unfavorable positions, the system allowed the adoption of more neutral postures, reducing the biomechanical load associated with the task. From a cumulative exposure perspective, these improvements acquire particular relevance. In care environments where transfers are repeated multiple times throughout a workday, even modest reductions in physical effort per transfer can translate into significant long-term benefits for caregiver health. The reduction of accumulated physical stress has the potential to decrease the incidence of musculoskeletal injuries, chronic fatigue, and work absenteeism. Although the present study did not directly evaluate occupational health indicators or injury rates, the qualitative observations and perceptions reported by participants are consistent with existing evidence linking reduced manual handling with improved ergonomic conditions in care work. In this sense, integrated transfer systems may play a relevant role in promoting safer and more sustainable patient handling practices for caregivers. Implications for health services Beyond individual effects on patients and caregivers, patient transfer processes have direct implications for the organization and performance of health services. Inefficiencies, delays, and transfer-related injuries can disrupt care workflows, increase discharge times, and overburden already limited human resources, especially in low-resource health systems. From an operational perspective, the pilot observations suggest that the integrated transfer system may contribute to more standardized and predictable transfer processes. Consistency in execution times and the reduction of improvised adjustments during the maneuver facilitate the planning and coordination of care activities, particularly in high-demand contexts. In high-volume institutions, where numerous wheelchair patient transfers are performed throughout the day, the accumulation of small efficiency improvements can generate significant system-level benefits. Reducing variability in transfer processes may contribute to better use of staff time, decreased delays, and greater fluidity in the patient’s pathway within the service. Caregiver workload constitutes a critical factor for the sustainability of health services. Repeated exposure to physically demanding tasks not only affects staff health, but also compromises continuity and quality of care. In this context, technologies that reduce physical effort and promote safer handling practices can have a positive impact on staff retention and organizational resilience. In low-resource settings, the feasibility of implementing assistive technologies depends largely on their cost, adaptability, and compatibility with existing infrastructure. The integrated transfer system analyzed in this study presents relevant advantages in this regard, as it does not require specialized vehicles or significant structural modifications. This characteristic facilitates its integration into current workflows and reduces barriers to adoption in care contexts with budgetary limitations. Discussion The present study examined the implications of a wheelchair-integrated transfer system from a health services–oriented perspective, with emphasis on patient safety, caregiver ergonomics, and the organization of care processes. Unlike approaches focused exclusively on technical performance, this work analyzes transfer as an integrated process involving multiple actors and operational conditions. The observations obtained during the pilot evaluation suggest that the integration of mobility and transfer functions into a single platform may address several of the persistent challenges associated with wheelchair-to-vehicle transfers. The reduction of height mismatches, improvement in movement control, and decrease in manual handling translated into a more predictable and stable transfer process. Compared with conventional transfer methods, such as manual lifting, transfer boards, or external hoist systems, the integrated system offers relevant operational advantages. While external devices may be effective in controlled clinical environments, their use in routine vehicle transfers is often limited by the need for additional time, specialized equipment, or environmental modifications. In contrast, a system integrated into the wheelchair may facilitate smoother transitions without significantly altering existing workflows. [ 6 ] The relevance of these findings is particularly notable in low-resource healthcare environments, where limitations in staffing, equipment, and infrastructure amplify the consequences of inefficient or unsafe transfer practices. In these contexts, solutions that combine operational simplicity with improvements in safety and ergonomics may contribute substantially to the sustainability of health services. From a health services research perspective, this study reinforces the importance of evaluating assistive technologies not only in terms of technical performance, but also in relation to their impact on care processes and organizational functioning. Adopting a service-oriented view makes it possible to identify benefits that may not be evident in evaluations focused exclusively on the device. [ 8 ] Limitations and future directions This study presents several limitations that should be considered when interpreting its results. First, the evaluation was exploratory in nature and was conducted with a limited number of participants and transfer scenarios. Although relevant descriptive data and qualitative observations were collected, the study was not designed to provide quantitative estimates of reductions in injury risk, ergonomic load, or adverse events. Second, the evaluation was based primarily on qualitative observations and simple perceptual scales, rather than standardized ergonomic or biomechanical analysis tools. Although this approach is appropriate for a pilot evaluation oriented toward health services, it limits direct comparison with studies that employ validated quantitative instruments. Future research should expand these findings through studies with larger samples and more diverse care contexts, incorporating quantitative ergonomic assessments, biomechanical analyses, and direct comparisons with conventional transfer methods. Likewise, longitudinal studies examining organizational indicators, such as staff injury rates, work absenteeism, and service efficiency, would be particularly valuable for assessing the long-term impact of this type of system. Conclusions This exploratory study analyzed the implications of a wheelchair-integrated transfer system from a health services–oriented perspective, focusing on patient safety, caregiver ergonomics, and organizational considerations in low-resource settings. The pilot observations suggest that integrating transfer assistance directly into the wheelchair may facilitate more controlled and predictable transfer processes, reducing dependence on manual handling. Beyond individual benefits, the results highlight the potential of these technologies to improve operational efficiency and the sustainability of health services. By contributing to safer and more ergonomically favorable transfers, integrated transfer systems may play a relevant role in optimizing care workflows and protecting staff health. Although further validation through larger studies is required, the findings support the relevance of continuing to explore integrated solutions that align technological innovation with the real needs of health services, particularly in contexts characterized by resource limitations. Declarations Ethics Statement This study was reviewed and approved at the institutional level by the Biomedical Engineering Research Group and the Polytechnic Faculty of the National University of Asunción (Paraguay), in accordance with institutional ethical guidelines for research involving human participants. The study included only non-invasive procedures, and all participants were adult volunteers who provided informed consent prior to participation. Acknowledgements The authors acknowledge the Biomedical Engineering Research Group and the Polytechnic Faculty of the National University of Asunción for the institutional support provided. They also acknowledge the Instituto de Previsión Social (IPS) for facilitating access to healthcare settings and all the volunteers who participated in the pilot evaluation. References World Health Organization (2023) Disability and health. World Health Organization, Geneva World Bank (2023) Disability inclusion overview. World Bank, Washington (DC) Waters TR, Dick RB (2015) Evidence of health risks associated with manual patient handling. Am J Ind Med 58(4):389–399 Nelson A, Baptiste AS (2004) Evidence-based practices for safe patient handling and mobility. Online J Issues Nurs 9(3):3 Hignett S, Fray M, Rossi MA (2014) Patient handling ergonomics in healthcare: A review. Ergonomics 57(4):481–503 Satpute SA, Uribe KJ, Olaore OO et al (2024) Time efficiency and ergonomic assessment of a robotic wheelchair transfer system. Sensors 24(23):7558 Zhang Z, Xu P, Wu C, Yu H (2024) Smart nursing wheelchairs: A new trend in assisted care and multifunctional integration. Biomimetics 9(8):492 Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS (2015) The influence of context on the effectiveness of health service interventions. Health Policy 119(7):845–854 Quintana E, Yegros C (2025) Design and implementation of a transfer system incorporated in a wheelchair prototype for transfer to cars. Res Square. 10.21203/rs.3.rs-8340258/v1 Additional Declarations The authors declare no competing interests. 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In the case of people with reduced mobility, these tasks acquire particular relevance, since they depend on wheelchairs or other assistive devices to perform transitions between different environments, surfaces, and means of transportation. Despite their routine nature, transfers represent one of the moments of greatest vulnerability for both patients and caregivers.\u003c/p\u003e \u003cp\u003ePatient transfers involve a complex interaction between the user, the caregiver, and the physical environment. Factors such as the height difference between surfaces, the space available for maneuvering, the patient\u0026rsquo;s body weight, the level of collaboration during the transfer, and the caregiver\u0026rsquo;s experience directly influence the safety and effectiveness of the process. When these factors are not adequately managed, the likelihood of instability, falls, abrupt movements, and adverse events during the transfer increases.\u003c/p\u003e \u003cp\u003eFrom the caregiver\u0026rsquo;s perspective, manual transfer tasks represent one of the main sources of physical workload within the healthcare setting. Numerous studies have documented the association between manual patient transfers and the occurrence of musculoskeletal injuries, particularly in the lumbar region, shoulders, and upper limbs. These injuries not only affect the health and well-being of healthcare personnel and informal caregivers, but also have relevant organizational consequences, such as work absenteeism, reduced operational capacity, and increased costs associated with care. [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWheelchair-to-vehicle transfers constitute a particularly challenging scenario within the set of transfer activities. Unlike transfers performed in controlled clinical environments, transfers to vehicles must adapt to confined spaces, non-standardized surfaces, and significant differences in seat height. These conditions hinder proper patient positioning and force the caregiver to adopt awkward postures and apply force in a sustained or sudden manner, increasing ergonomic risk and the likelihood of incidents.\u003c/p\u003e \u003cp\u003eIn low-resource health systems, these difficulties are exacerbated by multiple structural factors. Staff shortages, high patient volumes, and limited availability of specialized equipment mean that transfers are frequently performed using manual techniques or basic aids that provide limited mechanical support. In many cases, caregivers must resort to improvised solutions that rely heavily on individual experience and physical strength, introducing high variability in the quality and safety of the transfer process. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough assistive technologies designed to facilitate patient transfers exist, their adoption in low-resource settings is often limited by economic, logistical, and operational barriers. Many commercial devices require significant investments, structural modifications to vehicles or healthcare infrastructure, or present a level of complexity that hinders their integration into routine workflows. As a result, a gap persists between safe patient handling recommendations and actual transfer practices in numerous care contexts. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this scenario, there is a need to explore solutions that allow improving transfer safety and caregiver ergonomics without introducing additional operational burden for health services. Wheelchair-integrated transfer systems represent a potentially relevant alternative, as they combine mobility and transfer assistance functions within a single device. By being directly integrated into the wheelchair, these systems have the potential to reduce dependence on external devices, facilitate motion control, and adapt to diverse care environments.\u003c/p\u003e \u003cp\u003eThe present study is situated within this framework and adopts a health services\u0026ndash;oriented perspective to analyze the implications of a wheelchair-integrated transfer system. Beyond the technical evaluation of the device, the work focuses on understanding how this type of solution can influence patient safety, caregiver physical workload, and the organization of transfer processes within health services, particularly in contexts characterized by resource limitations. [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eHealth Services Context\u003c/h3\u003e\n\u003cp\u003eWheelchair users frequently require assistance to perform transitions between different care environments, including transfers from healthcare facilities to private or institutional vehicles, and vice versa. These transfers are part of the daily routine of numerous services, such as outpatient consultations, ambulatory rehabilitation, short-term hospitalizations, and hospital discharge processes. In institutions with high care volumes, the cumulative number of transfers can be considerable, magnifying the impact of inefficient or unsafe transfer practices.\u003c/p\u003e \u003cp\u003eIn public health systems serving large populations, especially in low- and middle-income countries, transfer tasks are carried out in a context of high demand and limited resources. Shortages of trained personnel, frequent caregiver turnover, and pressure to meet tight care schedules condition the way transfers are performed. In this setting, transfers often prioritize speed over ergonomics or process standardization, increasing variability and the risk associated with each maneuver.\u003c/p\u003e \u003cp\u003eFrom an organizational perspective, these processes have implications that go beyond the specific moment of the transfer. Difficulties during transfers can generate delays in care, prolong discharge times, increase staff fatigue, and contribute to the occurrence of musculoskeletal injuries. When these effects are repeated systematically, they negatively impact operational efficiency and the sustainability of health services.\u003c/p\u003e \u003cp\u003eIn this context, interventions aimed at improving the safety and predictability of transfers acquire strategic value. Assistive technologies that allow reducing manual handling, standardizing the transfer process, and decreasing caregiver physical workload can contribute to improving not only individual patient outcomes, but also the overall performance of the healthcare system. The integration of these solutions into existing workflows is particularly relevant in low-resource settings, where adaptability and compatibility with available infrastructure are key determinants for implementation.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eGeneral description of the wheelchair-integrated transfer system\u003c/h2\u003e \u003cp\u003eThe wheelchair-integrated transfer system analyzed in this study was conceived with the objective of facilitating safer and more controlled transfers between the wheelchair and the vehicle, without relying on external devices or requiring permanent modifications to the infrastructure or means of transportation. Unlike independent lifting systems, the design is integrated directly into the structure of the wheelchair, combining mobility and transfer assistance functions into a single device.\u003c/p\u003e \u003cp\u003eFrom a functional perspective, the system incorporates a vertical seat lifting mechanism together with a controlled rotation movement. This combination allows precise alignment of the wheelchair seat with the vehicle seat, reducing height differences and the lateral distance that the patient must travel during the transfer. These variables have been repeatedly identified in the literature as critical factors influencing patient stability and caregiver physical workload during transfer maneuvers.\u003c/p\u003e \u003cp\u003eThe vertical adjustment of the seat makes it possible to compensate for height differences between the wheelchair and the vehicle, which may vary significantly depending on the type of transportation used. In real care contexts, this variability includes everything from private vehicles to institutional transport units, each with different access configurations and seat heights. The system\u0026rsquo;s ability to adapt to these conditions contributes to a more predictable transfer process and reduces the need for corrective maneuvers during the execution of the transfer.\u003c/p\u003e \u003cp\u003eThe controlled rotation movement of the seat allows the user to be oriented toward the interior or exterior of the vehicle in a progressive and stable manner. This aspect is particularly relevant during the initial and final phases of the transfer, moments in which the greatest risks of instability are concentrated. By facilitating precise alignment, the system reduces the need for wide lateral displacements, which usually require greater physical intervention by the caregiver.\u003c/p\u003e \u003cp\u003eFrom the user\u0026rsquo;s point of view, the system is designed to allow active participation during the transfer, to the extent of the user\u0026rsquo;s functional capacities. The stability provided by the integrated mechanism favors the patient\u0026rsquo;s ability to collaborate in positioning and postural adjustment, which contributes both to safety and to the perception of control during the process. For the caregiver, this characteristic translates into a substantial change in role during the transfer, shifting from a function based on the application of physical force to a task focused on supervision and guidance of movement.\u003c/p\u003e \u003cp\u003eA key aspect of the design is its compatibility with standard vehicles and common care environments. The system does not require special anchoring points, external lifting platforms, or structural modifications to vehicles, which facilitates its integration into existing workflows. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] This characteristic is especially relevant in low-resource settings, where the availability of specialized infrastructure is limited and solutions must adapt to heterogeneous operational conditions.\u003c/p\u003e \u003cp\u003eAlthough a detailed technical description of the mechanical design, actuation system, and materials used has been previously presented in an independent technical preprint, in the present study the system is analyzed from a service-oriented perspective. The emphasis is not placed on isolated mechanical performance, but on the way in which the device interacts with the user, the caregiver, and the care environment, and on how this interaction may influence safety, ergonomics, and the organization of transfer processes. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePilot evaluation in a care context\u003c/h3\u003e\n\u003cp\u003eIn order to explore the practical implications of the integrated transfer system in real care scenarios, an observational pilot evaluation was conducted. Given the health services\u0026ndash;oriented focus of the study, the evaluation was designed to analyze the transfer process as a whole, rather than to generate quantitative clinical metrics or to validate the technical performance of the device under controlled laboratory conditions.\u003c/p\u003e \u003cp\u003eThe evaluation included the participation of adult volunteers from a hospital, both wheelchair users and participants without disabilities, who performed supervised wheelchair-to-vehicle transfers. The evaluation scenarios were hospital patient entry and exit areas, as well as ambulatory rehabilitation services and routine patient transport within the hospital, including reduced maneuvering spaces, variability in vehicle seat height, and the need for coordination between the user and the caregiver. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAll transfers were performed under supervision and under controlled safety conditions. No invasive procedures were carried out, and all participants provided informed consent prior to participating in the evaluation. The evaluation design prioritized systematic observation of aspects related to safety, ergonomics, and usability, rather than the measurement of specific clinical outcomes.\u003c/p\u003e \u003cp\u003eDuring each transfer scenario, structured observations were collected across multiple domains. These included patient stability during positioning and transfer, perceived safety throughout the maneuver, the physical effort required by the caregiver, posture adopted during the transfer, degree of control over the process, and the total time required to complete the transfer. Special attention was paid to the phases of the transfer that traditionally concentrate higher risk, such as initial seat alignment, lateral movement, and the initiation of the surface change.\u003c/p\u003e \u003cp\u003eA central element of the evaluation was the analysis of the interaction between the integrated transfer system and the care environment. Rather than isolating the performance of the device, the evaluation focused on understanding how the presence of the system modified the transfer process, the dynamics between patient and caregiver, and the predictability of the task within the care workflow. This approach made it possible to identify practical advantages and limitations that are particularly relevant from the perspective of healthcare service delivery.\u003c/p\u003e\n\u003ch3\u003eEnriched data from the pilot evaluation\u003c/h3\u003e\n\u003cp\u003eDuring the pilot evaluation, the integrated transfer system was tested in multiple wheelchair-to-vehicle transfer scenarios, involving a total of 120 adult volunteers and different transport configurations. Transfers were performed in vehicles with seat heights ranging approximately between 50 and 80 cm, reflecting the usual variability found in patient transport contexts.\u003c/p\u003e \u003cp\u003eThroughout the evaluation, approximately 160 lifting cycles were completed, with no structural failures, abnormal vibrations, or loss of system stability recorded. The time required for the vertical lifting phase during vehicle entry and exit maneuvers was approximately 7 seconds per cycle, while seat alignment and positioning required between 10 and 30 seconds, depending on the vehicle configuration and the specific conditions of each transfer.\u003c/p\u003e \u003cp\u003eThe integrated lifting and rotation mechanism made it possible to compensate for seat height differences of up to approximately 30 cm, reducing the lateral transfer distance within the range of 15 to 20 cm compared to conventional wheelchair-to-vehicle transfer methods. This reduction in lateral distance had a direct impact on the way the transfer was executed, decreasing the need for abrupt postural adjustments and facilitating a more continuous and controlled movement.\u003c/p\u003e \u003cp\u003eAlthough the evaluation was not designed to generate quantitative clinical outcomes or formal statistical comparisons, the descriptive data obtained provide a relevant operational perspective. The repeatability of the lifting cycles, the consistency of execution times, and the absence of functional failures suggest adequate operational feasibility of the system in typical care scenarios.\u003c/p\u003e \u003cp\u003eFrom a service-oriented perspective, these data acquire relevance when considered in relation to the accumulated volume of transfers performed in large institutions. The ability to complete critical transfer phases within predictable timeframes and with a high level of control may contribute to reducing process variability, a key factor for efficiency and planning in health services.\u003c/p\u003e\n\u003ch3\u003eImplications for patient safety\u003c/h3\u003e\n\u003cp\u003ePatient safety during transfer activities depends on multiple factors that interact simultaneously, including postural stability, movement control, process predictability, and coordination between the patient and the caregiver. Wheelchair-to-vehicle transfers represent a particularly sensitive scenario from this point of view, as they concentrate risk conditions associated with height differences, non-standardized surfaces, and limited maneuvering spaces.\u003c/p\u003e \u003cp\u003eThe observations made during the pilot evaluation indicated that the wheelchair-integrated transfer system contributed to a more stable and controlled transfer process, especially during the critical phases of seat alignment and lateral movement. By allowing progressive height adjustment and controlled seat rotation, the system reduced the need for abrupt movements and improvised adjustments, which are usually associated with loss of balance and incidents during transfers.\u003c/p\u003e \u003cp\u003eA relevant aspect observed was the improvement in the predictability of the transfer process. The ability to anticipate each phase of the transfer and execute movements sequentially allowed better coordination between the patient and the caregiver. This predictability not only reduces the risk of adverse events, but also contributes to generating an environment perceived as safer by the user, which may positively influence behavior during the transfer.\u003c/p\u003e \u003cp\u003eLikewise, the system promoted greater active participation of the patient in the transfer process. By providing a stable and controlled base, users were able to collaborate in positioning and postural adjustment according to their functional capacities. This active participation reduces the likelihood of unexpected movements and improves synchronization between patient and caregiver, factors that have been identified as key determinants of safety during transfers.\u003c/p\u003e \u003cp\u003eAlthough the pilot evaluation did not include quantitative metrics of adverse event reduction, the observed improvements in stability, control, and predictability are consistent with established principles of safe patient handling. From this perspective, wheelchair-integrated transfer systems may contribute to creating safer transfer conditions, particularly in environments where technological alternatives are limited.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eImplications for caregiver ergonomics\u003c/h2\u003e \u003cp\u003eManual patient transfer tasks constitute one of the main sources of physical workload and ergonomic risk for caregivers and healthcare personnel. Wheelchair-to-vehicle transfers, in particular, often require awkward postures, trunk flexion, sustained force application, and sudden movements, all of which are factors associated with an increased risk of musculoskeletal injuries.\u003c/p\u003e \u003cp\u003eDuring the pilot evaluation, it was observed that the integrated transfer system significantly reduced the need for manual lifting by the caregiver. Instead of supporting the patient\u0026rsquo;s body weight or performing improvised lifting maneuvers, caregivers were able to guide the transfer movement through system control. This change in transfer dynamics represents a transition from a force-based approach to an assisted and controlled process.\u003c/p\u003e \u003cp\u003eThe reduction in lateral transfer distance and the ability to adjust seat height contributed to improved caregiver postural alignment during the maneuver. By minimizing the need for excessive trunk flexion and force application in unfavorable positions, the system allowed the adoption of more neutral postures, reducing the biomechanical load associated with the task.\u003c/p\u003e \u003cp\u003eFrom a cumulative exposure perspective, these improvements acquire particular relevance. In care environments where transfers are repeated multiple times throughout a workday, even modest reductions in physical effort per transfer can translate into significant long-term benefits for caregiver health. The reduction of accumulated physical stress has the potential to decrease the incidence of musculoskeletal injuries, chronic fatigue, and work absenteeism.\u003c/p\u003e \u003cp\u003eAlthough the present study did not directly evaluate occupational health indicators or injury rates, the qualitative observations and perceptions reported by participants are consistent with existing evidence linking reduced manual handling with improved ergonomic conditions in care work. In this sense, integrated transfer systems may play a relevant role in promoting safer and more sustainable patient handling practices for caregivers.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImplications for health services\u003c/h3\u003e\n\u003cp\u003eBeyond individual effects on patients and caregivers, patient transfer processes have direct implications for the organization and performance of health services. Inefficiencies, delays, and transfer-related injuries can disrupt care workflows, increase discharge times, and overburden already limited human resources, especially in low-resource health systems.\u003c/p\u003e \u003cp\u003eFrom an operational perspective, the pilot observations suggest that the integrated transfer system may contribute to more standardized and predictable transfer processes. Consistency in execution times and the reduction of improvised adjustments during the maneuver facilitate the planning and coordination of care activities, particularly in high-demand contexts.\u003c/p\u003e \u003cp\u003eIn high-volume institutions, where numerous wheelchair patient transfers are performed throughout the day, the accumulation of small efficiency improvements can generate significant system-level benefits. Reducing variability in transfer processes may contribute to better use of staff time, decreased delays, and greater fluidity in the patient\u0026rsquo;s pathway within the service.\u003c/p\u003e \u003cp\u003eCaregiver workload constitutes a critical factor for the sustainability of health services. Repeated exposure to physically demanding tasks not only affects staff health, but also compromises continuity and quality of care. In this context, technologies that reduce physical effort and promote safer handling practices can have a positive impact on staff retention and organizational resilience.\u003c/p\u003e \u003cp\u003eIn low-resource settings, the feasibility of implementing assistive technologies depends largely on their cost, adaptability, and compatibility with existing infrastructure. The integrated transfer system analyzed in this study presents relevant advantages in this regard, as it does not require specialized vehicles or significant structural modifications. This characteristic facilitates its integration into current workflows and reduces barriers to adoption in care contexts with budgetary limitations.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e The present study examined the implications of a wheelchair-integrated transfer system from a health services\u0026ndash;oriented perspective, with emphasis on patient safety, caregiver ergonomics, and the organization of care processes. Unlike approaches focused exclusively on technical performance, this work analyzes transfer as an integrated process involving multiple actors and operational conditions.\u003c/p\u003e \u003cp\u003eThe observations obtained during the pilot evaluation suggest that the integration of mobility and transfer functions into a single platform may address several of the persistent challenges associated with wheelchair-to-vehicle transfers. The reduction of height mismatches, improvement in movement control, and decrease in manual handling translated into a more predictable and stable transfer process.\u003c/p\u003e \u003cp\u003eCompared with conventional transfer methods, such as manual lifting, transfer boards, or external hoist systems, the integrated system offers relevant operational advantages. While external devices may be effective in controlled clinical environments, their use in routine vehicle transfers is often limited by the need for additional time, specialized equipment, or environmental modifications. In contrast, a system integrated into the wheelchair may facilitate smoother transitions without significantly altering existing workflows. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe relevance of these findings is particularly notable in low-resource healthcare environments, where limitations in staffing, equipment, and infrastructure amplify the consequences of inefficient or unsafe transfer practices. In these contexts, solutions that combine operational simplicity with improvements in safety and ergonomics may contribute substantially to the sustainability of health services.\u003c/p\u003e \u003cp\u003eFrom a health services research perspective, this study reinforces the importance of evaluating assistive technologies not only in terms of technical performance, but also in relation to their impact on care processes and organizational functioning. Adopting a service-oriented view makes it possible to identify benefits that may not be evident in evaluations focused exclusively on the device. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future directions\u003c/h2\u003e \u003cp\u003eThis study presents several limitations that should be considered when interpreting its results. First, the evaluation was exploratory in nature and was conducted with a limited number of participants and transfer scenarios. Although relevant descriptive data and qualitative observations were collected, the study was not designed to provide quantitative estimates of reductions in injury risk, ergonomic load, or adverse events.\u003c/p\u003e \u003cp\u003eSecond, the evaluation was based primarily on qualitative observations and simple perceptual scales, rather than standardized ergonomic or biomechanical analysis tools. Although this approach is appropriate for a pilot evaluation oriented toward health services, it limits direct comparison with studies that employ validated quantitative instruments.\u003c/p\u003e \u003cp\u003eFuture research should expand these findings through studies with larger samples and more diverse care contexts, incorporating quantitative ergonomic assessments, biomechanical analyses, and direct comparisons with conventional transfer methods. Likewise, longitudinal studies examining organizational indicators, such as staff injury rates, work absenteeism, and service efficiency, would be particularly valuable for assessing the long-term impact of this type of system.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis exploratory study analyzed the implications of a wheelchair-integrated transfer system from a health services\u0026ndash;oriented perspective, focusing on patient safety, caregiver ergonomics, and organizational considerations in low-resource settings. The pilot observations suggest that integrating transfer assistance directly into the wheelchair may facilitate more controlled and predictable transfer processes, reducing dependence on manual handling.\u003c/p\u003e \u003cp\u003eBeyond individual benefits, the results highlight the potential of these technologies to improve operational efficiency and the sustainability of health services. By contributing to safer and more ergonomically favorable transfers, integrated transfer systems may play a relevant role in optimizing care workflows and protecting staff health.\u003c/p\u003e \u003cp\u003eAlthough further validation through larger studies is required, the findings support the relevance of continuing to explore integrated solutions that align technological innovation with the real needs of health services, particularly in contexts characterized by resource limitations.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eEthics Statement\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved at the institutional level by the Biomedical Engineering Research Group and the Polytechnic Faculty of the National University of Asunci\u0026oacute;n (Paraguay), in accordance with institutional ethical guidelines for research involving human participants. The study included only non-invasive procedures, and all participants were adult volunteers who provided informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the Biomedical Engineering Research Group and the Polytechnic Faculty of the National University of Asunci\u0026oacute;n for the institutional support provided. They also acknowledge the Instituto de Previsi\u0026oacute;n Social (IPS) for facilitating access to healthcare settings and all the volunteers who participated in the pilot evaluation.\u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2023) Disability and health. World Health Organization, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Bank (2023) Disability inclusion overview. World Bank, Washington (DC)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaters TR, Dick RB (2015) Evidence of health risks associated with manual patient handling. Am J Ind Med 58(4):389\u0026ndash;399\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNelson A, Baptiste AS (2004) Evidence-based practices for safe patient handling and mobility. Online J Issues Nurs 9(3):3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHignett S, Fray M, Rossi MA (2014) Patient handling ergonomics in healthcare: A review. Ergonomics 57(4):481\u0026ndash;503\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatpute SA, Uribe KJ, Olaore OO et al (2024) Time efficiency and ergonomic assessment of a robotic wheelchair transfer system. Sensors 24(23):7558\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Z, Xu P, Wu C, Yu H (2024) Smart nursing wheelchairs: A new trend in assisted care and multifunctional integration. Biomimetics 9(8):492\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS (2015) The influence of context on the effectiveness of health service interventions. Health Policy 119(7):845\u0026ndash;854\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuintana E, Yegros C (2025) Design and implementation of a transfer system incorporated in a wheelchair prototype for transfer to cars. Res Square. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21203/rs.3.rs-8340258/v1\u003c/span\u003e\u003cspan address=\"10.21203/rs.3.rs-8340258/v1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"National University of Asuncion","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health services research, Patient transfer, Assistive technology, Caregiver ergonomics, Patient safety, Wheelchair users, Low-resource healthcare settings","lastPublishedDoi":"10.21203/rs.3.rs-8833775/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8833775/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePatient transfers involving individuals with reduced mobility constitute a frequent activity within health services and represent a critical point in terms of patient safety, caregiver ergonomic load, and operational efficiency. Transfers from wheelchair to vehicle are particularly challenging, especially in low-resource settings, where the availability of assistive technologies is limited and transfers are usually performed using manual techniques.\u003c/p\u003e \u003cp\u003eThis study analyzes, from a health services research perspective, the implications of a wheelchair-integrated transfer system on care processes. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] An observational pilot evaluation was carried out during supervised wheelchair-to-vehicle transfers, focusing on aspects related to patient stability, caregiver physical effort, process predictability, and integration into routine workflows.\u003c/p\u003e \u003cp\u003e The observations suggest that the system allowed more controlled and standardized transfers, reducing manual handling and caregiver physical effort, and improving patient stability and participation. From an organizational perspective, the system showed potential to contribute to safer and more efficient transfer processes, with relevant implications for the sustainability of health services in resource-limited contexts.\u003c/p\u003e \u003cp\u003eAlthough this is an exploratory study, the findings support the need to continue evaluating integrated assistive technologies not only for their technical performance, but also for their impact on the organization and functioning of health services.\u003c/p\u003e","manuscriptTitle":"Implications of a Wheelchair-integrated Transfer System for Patient Safety, Caregiver Ergonomics, and Health Service Delivery in Low-resource Settings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 07:15:33","doi":"10.21203/rs.3.rs-8833775/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85084b10-35f7-41ff-87ad-27073a0e19ec","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":62633461,"name":"Biomedical Engineering"},{"id":62633462,"name":"Physical Medicine \u0026 Rehab"},{"id":62633463,"name":"Health Policy"}],"tags":[],"updatedAt":"2026-02-10T07:15:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 07:15:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8833775","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8833775","identity":"rs-8833775","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}