A high prevalence of manual wheelchair rear-wheel misalignment could be leading to increased risk of repetitive strain injuries.

We found that rear-wheel misalignment was prevalent and severe enough that it may increase the risk for RSIs and decrease participation. To mitigate this issue, future work should focus on reducing misalignment through improved maintenance interventions and increased manufacturing quality through more stringent standards.Implications for RehabilitationThe work reveals a previously unknown and significant contributor to RR that could have health implications for users who self-propel.Maintenance and repairs should be adjusted to help reduce the impact of misalignment.Our results suggests that WC designers should take additional care to designs wheels and frames to minimize misalignment.Service providers setting up wheelchairs should take additional care to make sure the wheels are aligned.Users should monitor misalignment and prioritize maintaining or having their chair repaired when misalignment occurs.