Pass It On Center - AT Reuse Strand
Research on AT Reuse Outcomes and Effectiveness
Lindsey Kampwerth, OTD OTR/L
Joy Kniskern, Principal Investigator
Pass It On Center
AT REUSE STRAND
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Pass It On Center - AT Reuse Strand
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Pass It On Center - AT Reuse Strand
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Pass It On Center - AT Reuse Strand
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Pass It On Center - AT Reuse Strand
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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)
qualitative & quantitative
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?
Measurable
WHY OUTCOMES?
• Abandonment
 Used for Program Evaluation
• Safety
and Continued Quality
•
Effectiveness
Assurance/Improvement
• Appropriateness
 Indicate whether the effects of
• Program Evaluation
the program are what was
intended
• Participation
(i.e.. improved community
• Consumer Feedback

participation, independent
living)
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
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
\

One Professional Group
n=5: 1 Physical Therapist, 2 Independent Living
Specialists, 2 Case Workers
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)
Income
Gender
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
 Non-Use
with
reutilized AT
 Level of difficulty
without AT
 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
Abandonment (n=6)



Mobility device
breakdowns (n=3)
Impairment changes
(n=2)
Provision of other AT
from family (n=1)


Discontinued Use (n=2)
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
Pass It On Center - AT Reuse Strand
VATNet (Virginia Assistive Technology Network)
The Business Case for AT Reuse In Virginia
•Outputs and Outcomes 9/2006- 9/2009, served:
4569 persons and gifted 5466 AT devices
98% of persons served were able to stay in home
84% decrease in falls
82% decrease in hospital admissions
99% feel AT improved their level of independence
Additional benefits: Getting back to work, getting back
school, shorter hospital stay, more participation in
Community activities
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Pass It On Center - AT Reuse Strand
VATNet (Virginia Assistive Technology Network)
• Estimated average cost per 100 persons served is
$465,585
• Based on number of persons served over the last two
years, VATNet has saved the Commonwealth $21,272,578
• Without necessary devices provide by (reuse)programs ,
clients reported they would have to go without the basic
necessities of life (prescriptions, food or utilities).
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Pass It On Center - AT Reuse Strand
Calculation of Cost Savings Impact of VATNet (2007-2008)
Persons Served
4,569
Gifted AT
5,466
Saved Commonwealth
$2,076,379
Outcomes Measures from Free Survey of 136 Virginian recipients of AT in 2006
Outcome
Unit Cost
Savings
Average Daily Cost =$1,149 x 5
26 hospital stays avoided
days
29 ER Visits
its prevented
Average Cost =$1,896
11 Moves to Skilled Nursing
to Skilled Nursing Facility
Facility
Avoided
Average Annual Cost =$74,095
Estimated 50 day stay
Average stay for discharged patients
is 272 days
11 Moves to Assisted Living Facility Avoided
Average Annual cost =$35,616
Estimated 50 day stay
112 Falls Avoided
Average Cost of Drs. Visit =$155
Estimated 1 in 4 falls would result
in drs. Visit
16 Job Losses Avoided
Poverty level income for family
of 3 in VA = $17, 170; 1/3 of
cost
$149,370
$54,984
$111,650
$53,668
$4,340
$91,573
estimated to be born by state.
Total cost savings for each 100 recipients served
Total historical cost savings of serving 4,560 recipients
$465,585
$21,272.58 51
Pass It On Center - AT Reuse Strand
Speaker e-mail contact
joy.kniskern@dol.state.ga.us
DISCLAIMER
This work is supported under five-year cooperative agreement
#H235V060016 awarded by the U.S. Department of Education,
Office of Special Education and Rehabilitative Services, and is
administered by the Pass It On Center of the Georgia Department
of Labor – Tools for Life. However, the contents of this publication
do not necessarily represent the policy or opinions of the
Department of Education, or the Georgia Department of Labor, and
the reader should not assume endorsements of this document by
the Federal government or the Georgia Department of Labor.
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