Spatial distribution and local clustering of wheelchair users in Wales: a cross-sectional ecological study

Efficient posture and mobility service delivery is critical for maintaining user independence and preventing secondary complications. In Wales, provision is currently centralised through four specialist centres. This study evaluates the spatial equity of these services by examining the geographic distribution of wheelchair users relative to service accessibility.

Data on 43,790 registered wheelchair users in Wales were obtained in December 2025 and aggregated to Lower Super Output Areas (LSOA). Spatial patterns were analysed using Global Moran's I and Local Indicators of Spatial Association to identify demographic clustering. Geographic accessibility was evaluated by calculating road-network travel times from LSOA centroids to the nearest NHS Posture and Mobility Service centre.

Results show statistically significant clustering of wheelchair users across all age groups, with the >65 cohort representing the largest demographic (49.1%). A distinct spatial inequity in service access was identified; while high-demand clusters in urban South and North-East Wales benefit from median travel times under 30 min, users in rural Mid- and West-Wales face significantly higher burdens. Despite comparable local demand intensities, clusters in Pembrokeshire, Ceredigion, and Powys experience median travel times approaching or exceeding 60 min.

The current centralised service model in Wales creates a "rural penalty" for both services and patients, failing to align infrastructure with the spatial distribution of clinical need. To address these disparities, this study recommends establishing additional satellite units in Mid- and West-Wales, to improve access to posture and mobility services or community care provisions. The optimal number and location of additional satellite sites requires formal investigation.