Research on Assistive Technology Reuse

1
Research on Assistive Technology Reuse Outcomes
and Effectiveness Lindsey Bean-Kampwerth, OTD,
OTR/L, Joy Kniskern, Principal Investigator,
Pass It On Center Contributors Kerri Morgan,
Carla Walker, Kim Walker, Aimee Duplantis,
Melissa Najarian
QUANITATIVE AT REUSE RESEARCH EXAMPLE
QUALITATIVE RESEARCH EXAMPLE
BACKGROUND

• BEYOND OUTPUTS TO OUTCOMES
• Outputs are raw data, such as numbers of device
  distributed or received.
• Outcome is a level of performance, or
  achievement. For example, how did the device
  affect the persons participation in daily
  activities?
• TYPES OF RESEARCH
• Qualitative research is concerned with
  subjective, narrative information, which
  typically is obtained under less structured
  conditions.
• Quantitative research involves measurement of
  outcomes using numerical data under standardized
  conditions.
• Case Study, or case series, may consist of a
  description of one or several patients, to
  document unusual conditions or the effect of
  innovative interventions.
• Surveys or Questionnaires are often used to
  collect descriptive information from small and
  large groups.
• MEASUREMENT
• Reliability - the extent to which a measurement
  is consistent and free from error
• Validity - ensures that a test is measuring what
  it is intended to measure.

• BACKGROUND
• The International Classification of Functioning,
  Disability, and Health (ICF) is formatted into
  two parts functioning disability and
  contextual factors.
• Functioning and disability are further separated
  into components called body functions and
  structures (this takes into account a person's
  strength or mobility). Activities and
  participation deal with the involvement in a life
  situation. Please see the diagram below.
• PURPOSE AIMS
• The purpose of this study was to gather more
  information about peoples use non-use of
  reused devices.
• METHODS
• Forty participants were contacted by telephone.
  Each participant had took part in a previous AT
  reuse study. While they were on the phone a
  semi-structured interview was completed. They
  were asked initial questions and then the
  remaining questions were open-ended. All of the
  interviews were transcribed and sorted into two
  groups one group used their AT reuse device and
  the other had stopped using their reuse device.
  Transcription example is below.
• RESULTS
• My chair doesnt just help me. It makes it
  possible for me to do tasks.
• Power wheelchair user
• D4 Mobility, D6 Domestic life
• Well its the only way I can bathe, so the
  shower bench is vital.
• Transfer bench user
• D5 Self-care

BACKGROUND The framework of this project was the
Institute of Medicines Enabling-Disabling
Process. When a person does not have an
impairment there is a good interaction between
the person and their physical, social and work
environment. When the person has an impairment,
the environment does not interact as well with
the person and the person can not fully do their
occupations. To improve the interaction between
the person and environment there are two options
that can be done together or individually. Option
1 is functional restoration. Functional
restoration focuses on improving the person, such
as increasing endurance, strength, or ROM. Option
2 is changing the environment by adding personal
assistance, changing the physical environment or
adding assistive technology, which is the focus
of Assistive Technology Reuse. PURPOSE
AIMS The purpose of this project was to develop
and implement an outcome measure to evaluate the
effectiveness of Paraquads Assistive Technology
Reutilization Program on personal care,
participation, and satisfaction with AT and
services. The specific aims were to develop an
outcome measure to track the effectiveness of
Paraquads AT Reutilization Program and to pilot
the outcome measure with recipients of the
program to examine if the consumer is using the
AT they received from the program, if they are
participating using the AT in Personal care and
Community activities, and to finally examine the
services of the program by finding gaps in the
program and the satisfaction of the clients with
the program. To do this the study had 3 phases.
METHOD Phase one included item development for
the AT reutilization survey. This included an
extensive literature review and reviewing prior
assessments. Phase two included qualitative
research using focus groups. These groups were
held to establish content validity of the survey
items and how Paraquads participant reviewed the
overall program. Phase three included a
retrospective quantitative study using the AT
reutilization survey. RESULTS The final survey
consisted of The Characteristics of Respondents
(CORE) which is used to collect demographic, such
as income benefits The Participation Survey
(PARTS/G) is used to measure the participation of
people who use assistive technology. It has 20
activities that stand on their own because each
has established internal consistency and
test-retest reliability. (Gray, Hollingsworth,
Stark, Morgan, 2006) and The Quebec User of
Evaluation of Satisfaction with Assistive
Technology (QUEST) is a measurement of
satisfaction with the AT device and services.
(Demers, L., Monetti, M., Lapierre, Y., Arnold,
D.L., Wolfson, C., 2002) The focus group
recommendations were to include items related to
falling, specify questions are only about their
AT reuse device, clarify the activity
definitions and select activities that were
relevant to AT use. The suggestions were used to
improve the survey. The results of the final
retrospective surveys included 34 of the 338
surveys being returned. The demographics are
below. Approximately 80 were satisfied or highly
satisfied with their AT reuse device and device
services. Thirty five respondents said they have
fallen in the past month. Of that, 35 people
34.3 and 20 said that falls limited their
participation a moderate amount and a great deal.
Then 26.5 of participants said that the AT
prevented them from falling most of the time and
35.3 said all of the time. One question in the
survey asked, With the device you received from
the program, the activity is____ then they could
rank it on a likert scale, impossible to very
easy. There was the same question except it asked
without the device you received from the
program. Taking the results from these two
questions the means where measured, using a
repeated measures t test to do this. There was
statistical significance with AT and without AT
for the 3 activities. See the graph below.
PHASE I Identify the Research Question
PHASE V Communication
Report findings Suggestions for further study
Identify the research problem
PHASE II Design the Study
Review of literature theoretical framework
Design the protocol Choose a sample
PHASE IV Data Analysis
Identify variables
Interpret findings
State Hypotheses Specify purpose
Analyze Data
PHASE III Methods
Most Difficult
Collect Data Reduce data
D4 MOBILITY d465 moving around using
equipment Moving the whole body from place to
place, or on any surface or space, by using
specific devices designed to facilitate movement
or create other ways of moving around or moving
down the street in a wheelchair or walker
Codes
d410 changing basic body position
d415 maintaining a body position
d420 transferring oneself
d430 lifting and carrying objects
d435 moving objects with lower extremities
d440 hand and arm use
d450 walking
d455 moving around
d465 moving around using equipment
d470 using transportation
d475 driving
Difficulty Average
Foundations of Clinical Research Application to
Practice, Portney Watkins
WHY IS RESEARCH SIGNIFICANT TO AT REUSE?
Least Difficult
Without AT
With AT
Gender
Female 72.6
Race
Black 47.9
White 47.0
Impairment
Mobility 93.2
Visual 35.0
Mental Health 29.9
Cognitive 17.1
Hearing 13.7
Income
0-14,999 56.4
Benefits
Social Security 84.6
Medicaid 58.1
Medicare 54.7
Age
28-93 Mean 56.0
Currently Use
Yes 79.5
Research is important to assistive technology
reuse for a number of reasons. First, research
directly influences the program and services,
then in return the program and services directly
influence the direction of the research. Second,
research is helpful in getting funding and
showing exactly how an Assistive Technology Reuse
program helps a person. Third, research increases
awareness and promotes the idea of Assistive
Technology Reuse. Lastly, he research can also
show how Reuse programs support the Green
Initiative, which could be another possible
funding store.