G.J. Gelderblom

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities

Abstract Objective: To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3–18 years). Method: Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers. Results: Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified. Conclusion: Evaluation of parents’ service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Effects and Effectiveness of Dynamic Arm Supports: A Technical Review

ABSTRACTNumerous dynamic arm supports have been developed in recent decades to increase independence in the performance of activities of daily living. Much effort and money have been spent on their development and prescription, yet insight into their effects and effectiveness is lacking. This article is a systematic review of evaluations of dynamic arm supports. The 8 technical evaluations, 12 usability evaluations, and 27 outcome studies together make 47 evaluations. Technical evaluations were often used as input for new developments and directed at balancing quality, forces and torques, and range of motion of prototypes. Usability studies were mostly single-measure designs that had varying results as to whether devices were usable for potential users. An increased ability to perform activities of daily living and user satisfaction were reported in outcome studies. However, the use of dynamic arm supports in the home situation was reported to be low. Gaining insight into why devices are not used when their developers believe them to be effective seems crucial for every new dynamic arm support developed. The methodological quality of the outcome studies was often low, so it is important that this is improved in the future.

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction

ABSTRACT There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3–17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.

Development of a Team-Based Method for Assuring the Quality of Assistive Technology Documentation

Good practice in assistive technology (AT) service delivery targeting children with disabilities has come increasingly to include providing AT stakeholders with a final text record that documents the rationale and procedures behind the recommendations made during the AT assessment process (AT documentation). In the present case study of one AT service provider, we developed a team-based approach for conducting an evaluation of the quality of the AT documentation. A service-specific scale for the evaluation of AT documentation was developed following a five-step approach. The scale was employed to review AT documentation utilizing specific review criteria in order to evaluate the quality of AT documentation practices with regard to the service investigated. Two independent reviewers examined the AT documentation for 130 cases of AT service provision. Weighted kappa and Intraclass correlation coefficients (ICC) were employed as a measure of inter-rater agreement. The results of the documentation evaluation allowed AT professionals to objectively assess the quality of the AT documentation produced by the service under investigation, identify shortcomings in the documentation process, and make related corrections. AT services may benefit from the employment of strategic approaches for the evaluation of service provision. Possible applications to other AT service providers are discussed.

European Instruments for Assistive Technology Outcome Assessment

The need for insight in cost effectiveness of Assistive Technology at both policy and individual level has led to the development of a number of generic instruments measuring the outcomes of Assistive Technology. Three important instruments, all emerged from the context of European funded projects, are described. First, a method combining an adaptation of EuroQol to Assistive Technology application, then IPPA, an highly individualised instrument assessing effectiveness and finally SCAI, a method for the economic evaluation of additional social costs resulting from the provision of an assistive device. The need for a strategy for further development of instruments is discussed resulting in a call for European collaboration.