Research on AT Reuse
Outcomes and
Effectiveness
Lindsey Kampwerth, OTD OTR/L
Kerri Morgan, MSOT OTR/L ATP
Contributors: Carla Walker, MSOT OTR/L ATP, Kim
Walker, OTD OTR/L; Aimee Duplantis, MSOT/S, Melissa
Najarian, MSOT/S
Presentation Overview
• General research knowledge
• Example of quantitative reuse data
• Example of qualitative reuse data
AT Reutilization Program for
Independent Living
Funded by:
Rehabilitation Services Administration
(H235V060047); Emerson Electric
Types of Data Collected
Inventory Data
–devices donated, sanitized, evaluated
repaired, distributed
Consumer Data
–Demographics
–Clinical Evaluation/Training
Longitudinal Data (outcomes)
Research
Programs
& Services
Beyond Outputs to Outcomes
–Outputs are raw data such as number of
devices distributed or received.
–Outcome is a level of performance, or
achievement.
WHAT ARE OUTCOMES? WHY OUTCOMES?
•
Measurable
•
Used for Program Evaluation
and Continued Quality
Assurance/Improvement
•
Indicate whether the effects
of the program are what was
intended
(i.e.. improved community
participation, independent
living)
•
•
•
•
•
•
•
Abandonment
Safety
Effectiveness
Appropriateness
Program Evaluation
Participation
Consumer Feedback
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 documents unusual
conditions or the effect of innovative interventions.
Surveys or Questionnaires are often used to collect
descriptive information from small and large groups.
Research Process
• Institutional Review Board (IRB)
–According to federal regulations,
projects funded through federal
agencies must be reviewed by an
institutional committee prior to
implementation to ensure that the
rights of research subjects are
protected.
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.
Portney & Watkins, Foundations of Clinical
Research: Applications to Practice
PHASE V
Communication
Report findings
Suggestions for
further study
PHASE I
Identify the Research
Question
Identify the research
problem
Review of literature:
theoretical framework
Identify variables
PHASE IV
Data Analysis
State Hypotheses
Specify purpose
Interpret findings
Analyze Data
PHASE III
Methods
Collect Data:
Reduce data
PHASE II
Design the Study
Design the protocol
Choose a sample
Example of Quantitative Data
Collected for a Reuse
Program
Study Design Timeline:
May 2006 – April 2008
Institute of Medicine - 1997
The Enabling - Disabling Process
Person without
Impairment
Person
with Impairment
1. Functional
Restoration
2. Assistive
Technology, Personal
Assistance, and
Environmental
Modifications
Good fit between
individual and
environment
Brandt & Pope, 1997
Bad fit between
individual and
environment
Statement of Purpose
• The purpose of the project was to
develop and implement an outcome
measure to evaluate the effectiveness
of Paraquad’s Assistive Technology
Reutilization Program on personal
care, participation, and satisfaction
with AT and services.
Outcome Survey
Development
Used and revised the following existing measures:
– Assistive Technology Characteristics Of
Respondents (CORE) Survey
Demographic and health information
– Participation Survey/General (PARTS/G)
Participation in major life activities
– Quebec User Evaluation of Satisfaction with
Assistive Technology (QUEST)
Satisfaction with device and services
Focus Groups
Content Validity
Three Participant Groups
–2 Mobility groups
n=7: 2 walkers, 2 scooters, 2 pwc,
1 mwc
n=4: 2 walkers, 2 canes
–1 Shower chair/commodes group
n=5: 4 shower chairs, 1 commode
Focus Groups Results
• Include items related to falling
• Specify only AT reuse device
• Clarify activity definitions
• Selected activities were relevant to
AT use
Retrospective Outcome Study
• Are participants using the reutilized
•
•
equipment?
• If no, why? (CORE)
• If yes, what activities are participants
using their equipment? (PARTS/G)
Is the provided AT reducing falls? (CORE)
How satisfied were the participants with the
device and program services? (QUEST)
Returned Surveys
Mailed 338 surveys
Returned surveys
N=117
34.6%
Shower chair/bench
n=38
32.5%
Raised toilet seat/commode
n=17
14.5%
Mobility devices
n=62
53.2%
Demographics (N=117)
Gender
Income
Female 72.6%
Race
Black
White
Impairment
Mobility
Visual
Mental Health
Cognitive
Hearing
$0-$14,999
56.4%
Benefits
47.9%
47.0%
93.2%
35.0%
29.9%
17.1%
13.7%
Social Security
84.6%
Medicaid
58.1%
Medicare
54.7%
Age
28-93 Mean 56.0
Currently Use
Yes
79.5%
Falling (N=117)
No
Have you fallen in
the past month? n=116 Yes
Have falls limited
participation in
activities in the
past month?
Has the AT
prevented you from
falling?
n=35
n=35
n=81
n=35
Not at all
A little
A moderate amount
A great deal
Never
A little of the time
Some of the time
Most of the time
All of the time
69.2%
29.9%
20.0%
25.7%
34.3%
20.0%
20.6%
5.9%
11.8%
26.5%
35.3%
Satisfaction with Device
(N=117)
100
Percent
80
60
40
20
0
Not Satisfied
Dimensions
Durability
Effective
More or Less
Weight
Ease of Using
Ease in Adjusting
Satisfied
Safe/Secure
Comfort
Satisfaction with Services
(N=117)
100
Percent
80
60
40
20
0
Not Satisfied
Service Delivery
More or Less
Repairs
Satisfied
Quality of professional services
Follow-Up
Mobility Group (n=62)
How often do you use the AT from the program when….
moving around your home?
leaving your home?
doing leisure activities?
Never
15.5%
Rarely
13.8%
Often
25.9%
Always
44.8%
Never
15.5%
Rarely
Often
13.8%
25.9%
Always
Never
Rarely
Often
Always
44.8%
17.0%
20.8%
32.1%)
30.2%
Difficulty With and Without AT
Difficulty Average
Most Difficult
Least Difficult
p<.001
Without AT
With AT
*significant
Moving Around Your Home
Leaving Your Home
Leisure Activities
Example of Qualitative Data
Collected for a Reuse
Program
Participant Demographics
(N=40)
Gender
%
Female
Race
Age at purchase
70.0
%
White
47.5
Black
45.0
Other
2.5
Income
%
$0-$14,999
57.5
$15,000-$34,999
22.5
$35,000-$55,000
5.0
Not ascertained
15.0
Mean
58.0
Range
28-91
Primary Impairment*
%
Mobility
90.0
Visual
30.0
Mental Health
25.5
Cognitive
12.5
Hearing
12.5
*multiple choice question
Method: Semi-Structured
Interview
• Initial questions to determine use or non-use
• AT and Reutilization Program Satisfaction
• Use
–Participation with
reutilized AT
–Level of difficulty
without AT
• Non-Use
–Contributing
factors
AT Acquired from Program
Device Type
Total
N=40
Mobility device
(cane, crutch, walker, manual or
power wheelchair)
n=24 (60.0%)
Shower chair or bench
n=11 (27.5%)
Raised toilet seat
or 3-in-1 commode
n=5 (12.5%)
Use and Non-Use at Time of
Interview
Device Type
Use
n=32
Non-Use
n=8
Mobility device
n=19 (79.2%)
n=5 (20.8%)
Shower chair or
bench
n=10 (90.9%)
n=1 (.09%)
Raised toilet seat or
3-in-1 commode
n=3 (60.0%)
n=2 (40.0%)
Data Analysis Procedures:
Coding
• Transcribed interviews
• Grouped into use and non-use
•
categories
Coded using the International
Classification of Functioning,
Disability, and Health (ICF)
Hseih & Shannon, 2005; World Health Organization, 2001
International Classification of Functioning, Disability, and
Health
Functioning
& Disability
Body
Functions and
Structures
Activities and
Participation
Contextual
Factors
Environmental
Factors
Personal
Factors
ICF Activities and Participation Domains
D1: Learning and applying knowledge
D2: General tasks and demands
D3: Communication
D4: Mobility
D5: Self-care
D6: Domestic life
D7: Interpersonal interactions & relationships
D8: Major life areas
D9: Community, social, and civic life
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
Participation
• Defined by the ICF as “involvement in
•
•
a life situation”
The ICF separates participation into 9
domains
Information about participation with
reutilized AT was determined from the
question
–What activities do you use your AT for?
“[My wheelchair] helps me.. to go
from one room to another, to go
outside, to go shopping, to go to
church and everything.”
Power wheelchair user
• D4: Mobility - moving with AT
• D6: Domestic life - acquisition of goods and
•
services
D9: Community, social and civic life - religion
and
spirituality
AT Use and Participation
ICF Participation Domain
Mobility
Device
Shower chair
or bench
Raised toilet
seat commode
D1: Learning and applying
knowledge
D2: General tasks and
demands
D3: Communication
•
D4: Mobility
•
•
•
D5: Self-care
•
•
•
D6: Domestic Life
•
D7: Interpersonal interactions
& relationships
•
D8: Major life areas
•
D9: Community, social, and
civic life
•
Without AT:
Participation Restrictions
Occur
“[My chair] doesn’t just help me. It makes
it possible for me to do tasks.”
Power wheelchair user
D4: Mobility, D6: Domestic life
“Well it’s the only way I can bathe, so
[the shower bench] is vital.”
Transfer bench user
D5: Self-care
Non-Use Participants
Discontinued Use
(n=2)
Abandonment (n=6)
•
•
•
Mobility device
breakdowns (n=3)
Impairment changes
(n=2)
Provision of other AT
from family (n=1)
•
•
Insurance paid for
new manual
wheelchair (n=1)
Impairment change
(n=1)
Program Evaluation
ICF Environmental Factor
E1: Products and technology
Facilitator
or Barrier
+
E2: Natural environment and humanmade changes to environment
E3: Support and relationships
+
E4: Attitudes
+
E5: Services, systems, and policies
+/-
Contact Information
Kerri Morgan MSOT OTR/L ATP
314-286-1659
morgank@wusm.wustl.edu
Lindsey Kampwerth OTD OTR/L
314-633-4744
lbean@paraquad.org