James A. Lenker

Psychometric and Administrative Properties of Measures Used in Assistive Technology Device Outcomes Research

Although there have been numerous calls for increasing the quantity and quality of assistive technology outcomes research, no one has analyzed the nature of data that the field has been accumulating. This article summarizes our evaluation of 82 outcome studies, published between 1980 and 2001, addressing assistive technology devices (ATDs). Our data indicate that the “typical” ATD outcomes study published in the past 20 years is one that (a) used a sample population that was diverse in terms of age, disability population, and type of ATD being used; (b) measured user-reported dependent variables with instruments designed specifically for the study; (c) did not report adequate information on the reliability and validity for the measurement instruments that were used; (d) did not discuss the staff workload associated with learning, administering, and scoring its data collection tools; and (e) did not differentiate its findings in terms of distinguishable participant subgroups. Several suggestions are provided to guide future development of assistive technology outcome measures in the domains of usability, quality of life, and social role performance. In addition, seven recommendations are offered to outcomes researchers, policy makers, journal editors, and reviewers in order to improve the reporting of assistive technology outcomes research.

Consumer perspectives on assistive technology outcomes

Abstract Purpose: The current study explored domains of assistive technology (AT) device outcomes that are most valued by AT users. A secondary objective was to identify elements in the device acquisition process that affect outcomes. Method: Focus groups were conducted at geographically dispersed locations within the USA. The groups were moderated by experienced AT practitioners who followed a detailed procedure emphasizing a nominal group facilitation technique. Results: Twenty-four adult AT users, representing a range of ages and disability populations, participated in four focus groups. Many had over 15 years of experience with multiple device types. Qualitative analysis yielded 13 threads that embodied salient outcome domains (e.g. independence, subjective well-being, participation in work and school, cost-effectiveness) and key factors associated with the device acquisition process (e.g. lengthy periods of frustration, variable quality of service providers). Ironically, these data were evoked only after the term “outcomes” was omitted from focus group questions. Conclusions: AT outcomes studies are needed that report data regarding (a) the impact of AT on participation, (b) costs of AT provision and (c) key elements in the AT service delivery process. Future studies will be further strengthened to the extent that their methodologies actively assimilate consumer perspectives. Implications for Rehabilitation Consumers highly value the impact of AT devices on their independence, subjective well-being and participation in work and school. The process of acquiring assistive technology devices is often lengthy and frustrating for consumers. Future AT outcomes research should report descriptive data regarding service delivery processes, as well as long-term impacts for consumers. Practitioners and researchers should avoid the use of potentially confusing professional jargon when administering surveys to consumers.

Conceptualization and measurement of assistive technology usability

Background. The concept of product usability has been discussed in several areas of product research and development. Usability, within the realm of assistive technology (AT) devices, determines how effectively and efficiently AT users with disabilities can function in different contexts and environments. Objectives. This article conceptualizes and proposes the significance of AT usability and its measurement in entirety from a human factors perspective. Conceptual models that characterize the interaction of the AT user, the AT device, the context and the involved activity is considered to be the hallmark of measurement of AT usability. On that basis, the article highlights the methodology and the initial progress of the development of an AT outcome tool, the Usability Scale for Assistive Technology (USAT), to measure self reported degree of AT usability. Methodology. In order to identify usability indicators for measurement, a qualitative study was conducted by exploring the experiences of AT users. Ten participants who used either wheeled mobility or computer based AT devices were interviewed with questions based on the theme of a usability framework. Results. The coded interview data generated more than 800 usability indicators specific to the two categories of AT devices. These indicators were mapped to a generic usability criteria list for construction of the USAT-Wheeled Mobility and the USAT-Computer Access. Implications. The USAT, when developed, is projected to be valid and useful for AT outcomes research as well as clinical practice. The use of the USAT will enable researchers and clinicians to comprehensively identify factors that underlie effectiveness and efficiency in AT device use and establish intervention protocols to optimize user-AT interaction.

Effects of an assistive technology intervention on older adults with disabilities and their informal caregivers: an exploratory randomized controlled trial.

ObjectiveThe aim of this study was to demonstrate experimentally that an assistive technology (AT) intervention improves older AT users’ activity performance and satisfaction with activity performance and decreases their caregivers’ sense of burden. DesignThis study was a delayed intervention, randomized control trial. Baseline data were collected on 44 community-dwelling AT user-caregiver dyads in Vancouver, British Columbia, and Montreal, Quebec. The primary outcome measures for AT users were the satisfaction and accomplishment scales from the Assessment of Life Habits. The primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure, which assessed burden associated with dyad-identified problematic activities. ResultsAfter the intervention, assistance users in the immediate intervention group reported significantly increased satisfaction with activity performance (P < 0.001) and improved accomplishment scores (P = 0.014). Informal caregivers in the immediate intervention group experienced significantly decreased burden with the dyad-identified problematic activity (P = 0.013). Participants in the delayed intervention group experienced similar benefits after the intervention. Improvements for both groups were mostly maintained 4 mos after the conclusion of the intervention. ConclusionsThis is the first experimental study to demonstrate that the provision of AT decreases caregiver burden. If confirmed and extended by subsequent research, the findings have significant policy and practice implications and may enable health care providers to advocate for improved access to AT provision and the related follow-up services.

How assistive technology use by individuals with disabilities impacts their caregivers: a systematic review of the research evidence.

ABSTRACTInformal caregivers are a critical yet frequently unacknowledged part of the healthcare system. It is commonly presumed that providing assistive technology will decrease the burden of their care provision; however, no review has evaluated the evidence behind this assumption. Therefore, a systematic review was undertaken to evaluate evidence of the impact of assistive technology use by care recipients on their informal caregivers. Data sources included EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area. Twenty-two studies met the specified inclusion criteria. Collectively, the findings suggest that assistive technology use helps caregivers by diminishing some of the physical and emotional effort entailed in supporting individuals with disability. However, confidence in this causal connection is limited because of the study designs that were used. This undermines the understanding of the impacts of assistive technology use on the users’ informal caregivers.

Treatment Theory, Intervention Specification, and Treatment Fidelity in Assistive Technology Outcomes Research

ABSTRACT Recent reports in the rehabilitation literature have suggested that treatment theory, intervention specification, and treatment fidelity have important implications for the design, results, and interpretation of outcomes research. At the same time, there has been relatively little discussion of how these concepts bear on the quality of assistive technology (AT) outcomes research. This article describes treatment theory, intervention specification, and treatment fidelity as interconnected facets of AT outcome studies that fundamentally affect the interpretation of their findings. The discussion of each is elucidated using case examples drawn from the AT outcomes research literature. Recommendations are offered for strengthening these components of AT outcomes research.

Classification of assistive technology services: Implications for outcomes research

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.

A tool for rapid assessment of product usability and universal design: Development and preliminary psychometric testing

BACKGROUND While there are many available tools and methods to evaluate product usability, few have been tested on user groups with disabilities and even fewer systematically consider universal design principles. OBJECTIVE This paper describes the development and preliminary psychometric testing of the Rapid Assessment of Product Usability & Universal Design (RAPUUD), a 12-item user-report tool based on the seven principles of universal design. METHOD A preliminary set of items was created to elicit ratings of diverse product characteristics (e.g., physical effort, cognitive effort, assistance required, safety). Data were gathered from 61 participants who rated the usability of products they use in their own environments. RESULTS Each item elicited a full range of responses, with no apparent floor or ceiling effects. Collectively, the 12 items achieved a high internal consistency (Cronbachs α=0.80). The data indicate that the tool was sensitive to differences in functional abilities, as well as differences in product characteristics. The instrument was usable for a range of consumer products, though not all items were appropriate for each and every product. CONCLUSION The results suggest that the instrument could become a pragmatic tool for designers to identify usability problems experienced by a diversity of user populations.

Development of the Usability Scale for Assistive Technology-Wheeled Mobility: A preliminary psychometric evaluation

The article describes the methodology and psychometric evaluation of an assistive technology (AT) outcomes measure- ment tool, the Usability Scale for Assistive Technology-Wheeled Mobility module (USAT-WM), as a tool to capture user-centered usability of wheeled-mobility devices. The construction of the USAT-WM was driven by a qualitative inquiry focusing on the experiences of users of wheeled mobility devices. The interview content was coded and nearly 400 indicators pertaining to usability of wheeled-mobility devices were assimilated to construct a preliminary version of the USAT-WM. The content validity of the USAT-WM was evaluated by a panel of clinicians in the field of wheeled-mobility. The findings from the content validation process were utilized to revise the USAT-WM. A field-test of the USAT-WM was conducted by administering it to 70 individuals who used power wheelchairs (PWCs) for mobility. A preliminary principal component analysis of the instrument sections was performed, and based on the item loading a subsequent factor analysis was conducted to establish a 50-item version of the USAT-WM with seven subscales: home usability; workplace/school usability; community usability; outdoor usability; ease of use; seating; and safety. Internal consistency Cronbachs alpha values for the seven subscales ranged from 0.77 to 0.91 and 0.90 for the total score of the USAT-WM. The test- retest and alternate-form reliability of the USAT-WM scores correlated at 0.85 ( p< 0.01). The convergent validity correlations of the USAT-WM with the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST2.0) and the Psychosocial Impact of Assistive Devices Scale (PIADS) were found to be 0.55 ( p< 0.01) and 0.30 ( p< 0.01) respectively.

Professional education programs in rehabilitation engineering and assistive technology

Historically, rehabilitation engineering and assistive technology practitioners have received inconsistent pre-professional training. A survey of current post-secondary professional curricula reveals several facets of rehabilitation engineering and assistive technology educational models that remain diverse. Suggestions for improvement and standardization of educational curricula are given based on the body of literature related to pre-professional education of practitioners, as well as anticipated certification and accreditation efforts by the fields principal credentialing body.