Technology and Disability - Volume 24, issue 1

Authors: Soede, Thijs

Article Type: Editorial

DOI: 10.3233/TAD-2012-0345

Citation: Technology and Disability, vol. 24, no. 1, pp. 1-4, 2012

Authors: Brandt, Åse | Alwin, Jenny

Article Type: Editorial

DOI: 10.3233/TAD-2012-0338

Citation: Technology and Disability, vol. 24, no. 1, pp. 5-7, 2012

Authors: Anttila, Heidi | Samuelsson, Kersti | Salminen, Anna-Liisa | Brandt, Åse

Article Type: Research Article

Abstract: This overview summarizes the available evidence from systematic reviews of outcomes studies on various assistive technologies (AT) for persons with disabilities. Systematic reviews published between January 2000 and April 2010 were identified by comprehensive literature searches. Study selection, data extraction and methodological quality evaluation were done by two authors independently. The quality of evidence was summarized by explicit methods. Types of disabilities, settings, and AT interventions were recorded. Outcomes were mapped according to the Taxonomy of Assistive Technology Device Outcomes. Forty-four systematic reviews were included in this overview. High-quality evidence was found in single AT (positive effects of providing AT …in connection with home assessment and hearing aids, no effects of hip protectors) for limited populations (older people at home, people with hearing loss, and older people in institutional care, respectively). Low-quality or unclear evidence was found for the effectiveness of the other evaluated AT interventions. Current gaps in AT outcomes research were identified. Many frequently used devices have not been systematically reviewed. Well-designed outcomes research to inform clinical decision-making is urgently needed. The systematic review methodology seems to be feasible for summarising AT outcomes research, but methodological development for grading and for primary studies is warranted. Show more

Keywords: Self-help devices, assistive technology devices, aids, equipment, evidence, outcome assessment, rehabilitation, health care

DOI: 10.3233/TAD-2012-0332

Citation: Technology and Disability, vol. 24, no. 1, pp. 9-48, 2012

Authors: Vincent, Claude | Routhier, François

Article Type: Research Article

Abstract: Background: Therapists need information about assistive technology (AT) outcomes linked to life habits (activities in real life). However, the scientific literature seems to be almost non-existent in many life habit domains, and when it does exist, it may not be relevant to clinics because of the characteristics of the research designs. Objective: To examine what kinds of research designs are used to assess outcomes of AT use in real life situation and to discuss the usefulness of different designs for therapists in clinical practice. Method: A limited search in PubMed and OT Seeker was performed in …June 2010 using the keywords “assistive AND technology AND device AND outcome”. Results: Of the 499 references found, 19 studies met our inclusion criteria. Six of the research designs were experimental (randomized controlled trial: n = 6 ), four were quasi-experimental (longitudinal: n = 2 , multiple baseline: n = 2 ) and nine were non-experimental (survey and follow-up: n = 4 , case study: n = 1 , case report: n = 2 , correlational research: n = 1 , multiple cohort: n = 1 ). Eleven types of AT were assessed. Discussion and conclusion: We found that the studies that give more useful information for therapists in clinics include research designs with short and long term effects of AT, use of standardized tools that point out the possible life habits where AT should be helpful, and a strategy to control confounders (group comparison, alternative condition for AT use, repetitive measures). Show more

Keywords: Assistive technology, assessment, outcome measure, life habits, research design

DOI: 10.3233/TAD-2012-0333

Citation: Technology and Disability, vol. 24, no. 1, pp. 49-58, 2012

Authors: Lenker, James A. | Shoemaker, Laura L. | Fuhrer, Marcus J. | Jutai, Jeffrey W. | Demers, Louise | Tan, Chuan Hoh | DeRuyter, Frank

Article Type: Research Article

Abstract: This paper evaluates four classifications of assistive technology (AT) services for their ability to support outcomes research. The evaluation involved classifications intended for various purposes, including those created to support practitioner education and third-party reimbursement decisions. Each was analyzed according to a common framework: a) purpose, b) completeness, c) granularity, and d) research application. Each classification addresses the gamut of service provision steps, including client intake, assessment, and training, as well as device maintenance and repair. The classifications differed markedly in the granularity with which each step is described. None of the classifications attempts to dimensionalize the service provision steps …in terms of intensity, duration, frequency, or other indicators of service quality. The findings suggest that existing AT service classifications do not fully meet the needs of AT outcomes researchers. A common taxonomy of AT services is thus needed to advance the science of AT device outcomes research. A preliminary classification of services is presented as a basis for future development. Show more

Keywords: Classification, taxonomy, assistive technology services, assistive technology devices, outcomes research

DOI: 10.3233/TAD-2012-0334

Citation: Technology and Disability, vol. 24, no. 1, pp. 59-70, 2012

Authors: Hoenig, Helen | Landerman, Lawrence R. | Shipp, Kathy M. | Richardson, Margaret | Pieper, Carl | Winkler, Sandra Hubbard

Article Type: Research Article

Abstract: Objectives: To explore whether use of wheeled mobility devices 4 months after receipt can be predicted based on the type of information available at the time of initial wheelchair prescription/provision across diverse settings and providers. Design: Longitudinal cohort study. Setting: One private teaching hospital and one Department of Veterans Affairs Medical Center. Participants: 86 consecutive, community-dwelling, cognitively intact persons with a wide range of diagnoses newly prescribed a wheeled mobility device. Interventions: Provision of a manual or motorized wheelchair, or scooter. Measurements: The dependent variable was self-reported device use (any …versus none) 4 months after initial prescription; independent variables were self-reported medical conditions and impairment, activity limitations, personal and environmental contextual factors. Results: More than half (56.8%) of the subjects were still using their new wheeled mobility device 4 months after receipt. In bivariate analysis, persons still using the device were significantly (p < 0.05 ) more likely to report that they had experienced confusion in the prior 6 months, that their doctor had told them they had mental problems such as depression/and or anxiety, or that amputation was the reason they were prescribed a wheelchair. They were less likely to report being hospitalized in the previous 6 months. In the final multivariable model, based on stepwise regression, a history of recent confusion or prior amputation significantly increased the odds of continued device use (Odds Ratio [OR] 6.8 and 14.4 respectively) while recent hospitalization or prior fracture significantly decreased the odds (OR 0.15 and 0.30 respectively). An Index predicting wheelchair use, using weights for these 4 variables based on the multivariable regression, was significantly related to device use in 100 bootstrap replicate samples, with an average beta=1.03, OR=2.80, p < 0.001 . Depending on the specific combination of variables, the sensitivity of the Index ranged from 0.07 to 0.94 for predicting wheelchair use and the specificity of the Index ranged from 0.27 to 0.99. Conclusions: Although preliminary, the study shows that it is possible to provide evidence-based prediction for short-term use of a new wheeled mobility device, based on information likely to be available at the outset. Show more

Keywords: Mobility disability, wheelchair, self help devices, predictive model, delivery of health care, statistical model, prognosis

DOI: 10.3233/TAD-2012-0335

Citation: Technology and Disability, vol. 24, no. 1, pp. 71-81, 2012

Authors: Watson, Anne H. | Smith, Roger O.

Article Type: Research Article

Abstract: Background: Little research exists on the effectiveness of assistive technology (AT) for children and almost no outcome instruments exist. The Student Performance Profile (SPP) and the School Function Assessment-Assistive Technology (SFA-AT) are instruments %are specifically designed to measure AT outcomes in special education. Purpose: The present study reports on the measurement properties and compares the time needed to use the SFA-AT and the SPP. Materials and methods: The SFA-AT and the SPP were used to measure the effect of AT for 13 children with intellectual, behavioural, or learning disabilities in a public school, and were compared …regarding time acceded for their administration, rating and scoring, and measurement properties. Findings: The SPP required less time to administer, score, and analyse than the SFA-AT. Both were sensitive to change in student performance over a four-month period when the conditions of pretest without AT was compared to posttest with AT. The SFA-AT scores did not correlate with the SPP scores at pretest without AT or at posttest with AT. Conclusions: Both the SFA-AT and the SPP have advantages, but the SPP appeared most efficient and sensitive for this population of students in special education. Further studies with larger and alternate participant samples are required. Show more

Keywords: Assistive technology, outcomes, school, children, measurement instrument, Student Performance Profile (SPP), School Function Assessment-Assistive Technology (SFA-AT)

DOI: 10.3233/TAD-2012-0336

Citation: Technology and Disability, vol. 24, no. 1, pp. 83-92, 2012

Authors: Persson, Jan | Husberg, Magnus

Article Type: Research Article

Abstract: In decision making on the adoption of health care programmes, assistive technologies (ATs), and AT services for people with disabilities, cost-effectiveness analysis is increasingly important. The quality-adjusted life-year (QALY), which incorporates quality of life as well as survival, has become a standard unit of comparative efficacy, although there are methodological challenges in its use. The applicability of the concept of cost per QALY gained through intervention was investigated in one study of rollators and one of hearing aids. It was shown that two widely used instruments for deriving QALYs, HUI3 and EQ-5D, yield differing results, which may also differ depending …on the type of disability. Because the magnitude of these differences could affect decision makers' willingness to provide reimbursement, the variability of cost-effectiveness results due to methodology should be considered in the policy-making process. Show more

Keywords: Cost-effectiveness analysis, QALY, EQ-5D, HUI3, assistive technology

DOI: 10.3233/TAD-2012-0337

Citation: Technology and Disability, vol. 24, no. 1, pp. 93-100, 2012