Documentation of and satisfaction with the service delivery process of electric powered scooters among adult users in different national contexts

The impact of a crisis on the provision of assistive technology in Sweden: the case of COVID-19

The entitlement to access assistive technology (AT) is fundamental for all individuals. However, challenges encountered during societal crises can significantly impact opportunities for participation and engagement among AT users. Understanding the implications of crises and disasters on AT provision along with their repercussions for end users is crucial. This research endeavors to investigate the experiences of managers overseeing AT provision during crises, using the first wave of the COVID-19 pandemic as a case study. An open-ended questionnaire was distributed to health care managers (n = 18) within AT organizations in Sweden. The responses were analyzed using qualitative content analysis, and four categories derived: Embracing change and navigating new realities, Optimizing strategies due to decreased and limiting prescriptions, Unlocking access and addressing challenges in AT provision, The impact on the staff and their well-being vs effectiveness in the AT organization. The findings indicate that AT organizations have demonstrated remarkable resilience and adaptability in the face of reduced consultations and growing care burden. Despite these challenges, managers have gained valuable insights into developing AT provision more efficiently and sustainably, particularly in digitization. The lessons learned will be critical in ensuring AT provision remains responsive to the needs of patients and society in the future.

Barriers and facilitators of assistive technology service delivery process (AT-SDP) in South Korea

PURPOSE

To describe the barriers and facilitators of the assistive technology service delivery process (AT-SDP), based on the perspectives of assistive technology service professionals (ATPs) and assistive technology (AT) service users.

METHODS

We conducted semi-structured interviews with nine AT users and eight ATPs in South Korea. The data were analyzed using a constant comparative approach based on the grounded theory.

RESULTS

AT users and ATPs identified common barriers in the assessment, matching, and implementation of the AT-SDP. In the assessment process, the preparation of detailed selection criteria was suggested for assistive technology devices (ATDs). Insufficient linkages on assessments among institutions providing AT services was a reported barrier, and standardized evaluation tools were suggested to address this issue. In the matching process, to meet users' needs, versatility in the characteristics or type of ATD was highlighted. In the implementation process, participants emphasized the need to shorten the time required during the delivery process. Along with these facilitators, institutional support, including staffing securement, the establishment of AT centres, and funding policies were recommended to facilitate the AT-SDP.

CONCLUSIONS

Our results highlight the importance of government support and considering realistic funding levels to overcome the barriers reported by AT users and ATPs.

Assistive technology, information asymmetry and the role of brokerage services: a scoping review

OBJECTIVES

Access to assistive technologies (ATs) is a human right for people with disabilities, but there are a range of barriers, including lack of adequate information. This review aimed to explore the implications of information asymmetry on the delivery of AT and to investigate if there are effective and equitable ways of providing AT brokerage services to people needing AT.

DESIGN

Scoping review.

DATA SOURCES

EBSCO Medline, EBSCO Cinahl, Academic Search Ultimate, Business Source Ultimate, Proquest Central, Scopus, Web of Science, PsychINFO, EconLit and JSTOR were searched through 18 July 2021.

ELIGIBILITY CRITERIA

Intervention and observational studies and articles directly related to information asymmetry and brokerage in the context of AT were included. In addition, a scan of web-based resources and services was undertaken.

DATA EXTRACTION AND SYNTHESIS

Four authors independently screened the articles for inclusion and performed a narrative synthesis.

RESULTS

Thirty-three articles were identified. The narrative synthesis showed that: (1) AT users want access to impartial information sources; (2) users want to be involved in AT selection; (3) users benefit from access to demonstration sites; (4) users want access to training and ongoing support in their use of AT; and (5) users want access to information on new and emerging technologies. Access to information and user engagement, we produced better outcomes and satisfaction. Web-based repositories are valuable for user research and peer feedback, while demonstration sites address the need for expert advice, trial use of equipment, training and support in equipment use and maintenance.

CONCLUSIONS

Access to impartial information brokerage is critical to optimise AT selection. The implications of information asymmetry include lower user satisfaction, equipment underutilisation or abandonment. Aspects such as access to demonstration sites and web-based resources were also important.

Service delivery for complex rehabilitation technology: a scoping review

PURPOSE

Complex rehabilitation technologies (CRT) support independence for individuals with disabilities by enabling mobility for function, employment, education, and independent living. CRT service delivery is evolving, with changes to funding, provider qualifications, consumer needs, and technological advances. This scoping review investigated service delivery processes for individuals with disabilities who have a mobility impairment, while specifically identifying best practices, barriers, and unique features of health delivery policies and practices.

METHODS

We used a framework described by Colquhoun et. al. for conducting scoping reviews, a six-step process that includes: 1) identifying the research question, 2) identifying studies, 3) selecting studies 4) data charting, 5) reporting results and 6) consultation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was also used for reporting results of the review.

RESULTS

Common categories were identified and organised into a hierarchical structure of four categories and 16 sub-categories. The primary categories included "policy", "consumer", "service delivery", and "wheeled mobility devices". The sub-categories described funding sources, consumer and professional populations, service delivery guidelines, and types of mobility devices. Analysis indicated the data were from 21 countries and 14 combinations of funding sources, and the articles were primarily descriptive studies.

CONCLUSION

This scoping review identified evidence from various countries, health systems, and stakeholder. Currently, this process does not proactively address the needs of individuals with mobility disabilities. The scoping review provides the foundation for the development of a novel policy on the provision of CRT services and devices to address these needs.Implications for RehabilitationExamination of national and international service delivery practices in diverse clinical and funding environments indicate various challenges and opportunities for improvement.CRT consumers are negatively impacted by current service delivery practices, including long wait times, lack of specialised clinical expertise, and limited consumer education opportunities.More consistent and widespread research is needed within the CRT provision industry to grow evidence-based practice related to complex rehabilitation technology and individuals with disabilities.

Wheelchair and seating assistive technology provision: a gateway to freedom

Aim: The meaning of wheelchair and seating assistive technology and the impact inappropriate provision has on people's lives from a service user's perspective within an Irish context is highlighted. There is a dearth in evidence examining the process of wheelchair and seating provision and the interconnectedness between satisfaction, performance and participation from an equality and human rights perspective. The purpose if the study is to investigate wheelchair service users' perspectives of wheelchair and seating provision in Ireland.Method: This is a mixed-methods study with an exploratory sequential design that includes two phases. During phase one, wheelchair service users were invited to take part in qualitative in-depth semi-structured interviews, which were thematically analysed and formed part of a larger ethnographic study involving multiple stakeholders in sustainable wheelchair and seating provision strategy development. In phase two, an online Survey Monkey questionnaire was distributed to obtain a wider overview of wheelchair service provision from a wheelchair service users perspective. Data obtained from the closed questions and content analysis for open comments was analysed descriptively for this phase.Results: Eight wheelchair service users agreed to participate in the interviews and 273 responded to the online survey. Thematic analysis and questionnaire frequency and content analysis revealed the vital meaning of wheelchair and seating assistive technology provision. However, bottlenecks within the system affect daily living, with qualitative data highlighting the obstruction to experiences of independent living from initial appointment to wheelchair breakdowns during daily life.Conclusion: Appropriate wheelchair and seating assistive technology provision is a basic human right, supported by the essential and embodied nature of the wheelchair as demonstrated through the wheelchair service users' perspective throughout this study. These findings highlight the impact of ad-hoc services on individual freedoms and how the overall pace of the system affects a person's ability to organise their time as an equal member of the community across the lifespan. A national review of wheelchair and seating assistive technology provision services is called for, giving consideration to access to services, assessment and delivery, follow up and management, education and training.IMPLICATIONS FOR REHABILITATIONWheelchair and seating assistive technology provision as a basic human right is misunderstood.Appropriate wheelchair and seating assistive technology provision should be provided to meet this primary need as a pre-requisite for survival.Every aspect of the wheelchair and seating provision process impacts on occupational performance, equality of opportunity and community mobility. Wheelchair and seating assistive technology professionals and providers have a responsibility to review their practice and service provision systems.

The effects of assistive technology service delivery processes and factors associated with positive outcomes - a systematic review

Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes.Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n ≥ 10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias.Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies.Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice.Implications for rehabilitationAssistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective.New digital technologies could be used to improve the AT-SDP and reduce costs.Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user's needs for training.

Content analysis to locate assistive technology in Queensland's motor injury insurance rehabilitation legislation and guidelines

INTRODUCTION

Reforms to Australia's disability and rehabilitation sectors have espoused the potential of assistive technology as an enabler. As new insurance systems are being developed it is timely to examine the structure of existing systems. This exploratory study examined the policies guiding assistive technology provision in the motor accident insurance sector of one Australian state.

METHODS

Policy documents were analyzed iteratively with a set of qualitative questions to understand the intent and interpretation of policies guiding assistive technology provision. Content analysis identified relevant sections and meaningful terminology, and context analysis explored the dominant perspectives informing policy.

RESULTS AND DISCUSSION

The concepts and language of assistive technology are not part of the policy frameworks guiding rehabilitation practice in Queensland's motor accident insurance sector. The definition of rehabilitation in the legislation is consistent with contemporary international interpretations that focus on optimizing functioning in interaction with the environment. However, the supporting documents are focused on recovery from injuries where decisions are guided by clinical need and affordability.

CONCLUSION

The policies frame rehabilitation in a medical model that separates assistive technology provision from the rehabilitation plan. The legislative framework provides opportunities to develop and improve assistive technology provision as part of an integrated approach to rehabilitation.

Satisfaction with assistive technology device in relation to the service delivery process-A systematic review

The service delivery process (SDP) of assistive technology devices (ATDs) is attracting interest, as the provision of ATDs is critical for the independence and participation in society of individuals with disabilities. The purpose of the current study was to investigate what impact the SDP has on satisfaction with ATDs in individuals with disabilities in relation to everyday activities. A systematic literature review was conducted, which resulted in 53 articles included. The results showed that there are factors in almost all the different steps of the SDP that affect the satisfaction with of the devices, which can lead to underutilization and abandonment of ATDs. Only a few studies have been conducted with a design robust enough to generalize the results; therefore, more research is needed. Therefore, the conclusion is the SDP as a whole contributes to the satisfaction with and usability of ATDs in individuals with disability in relation to achieving the desired goals of participation in everyday activities, for the articles included must be deemed as moderate. A client-centred approach in the process is advocated, and was found to be an important factor for an effective SDP and satisfied users.

Adult Scandinavians' use of powered scooters: user satisfaction, frequency of use, and prediction of daily use

PURPOSE

To investigate user satisfaction with characteristics of powered scooters (scooters), frequency of use, and factors predicting daily scooter use.

DESIGN

Cross-sectional.

SAMPLE

Adult scooter users (n = 59) in Denmark and Norway, mean age 74.5 (standard deviation 12.3) years.

METHODS

Structured face-to-face interviews. The NOMO 1.0, the Quebec User Evaluation of Satisfaction with assistive devices (QUEST 2.0), and a study specific instrument were used to collect data. Descriptive statistics were applied, and regression analyzes were used to investigate predictors for daily scooter use. The International Classification of Functioning, Disability and Health (ICF) served as a framework for classifying variables and guiding the investigation.

RESULTS

Satisfaction with the scooter characteristics was high with most participants being very satisfied or quite satisfied (66.1-91.5%). Most scooters were used daily (36.2%) or several times a week (50.0%). User satisfaction with safety of the scooter [odds ratio (OR) = 11.76, confidence interval (CI) = 1.70-81.28] and reduced balance (OR = 5.63, CI = 0.90-35.39) increased the likelihood of daily use, while reduced function in back and/or legs (OR = .04, CI = 0.00-0.75), tiredness (OR = .06, CI = 0.01-0.51), and increased age (OR = .93, CI = 0.87-1.00) reduced the likelihood of daily use. 52.8% of the variance was explained by these variables.

CONCLUSIONS

User satisfaction was high, and most scooters were used frequently. User satisfaction with safety, specific functional limitations and age were predictors for daily scooter use. Implications for Rehabilitation Scooters seem to be a beneficial intervention for people with mobility impairment: user satisfaction and frequency of use are high. Users' subjective feeling of safety should be secured in the service delivery process in order to support safe and frequent scooter use. Training of scooter skills should be considered in the service delivery process.

Psychometric properties of the NOMO 1.0 tested among adult powered-mobility users

Background.

The Nordic Mobility Related Outcome Evaluation of Assistive Device Intervention (NOMO 1.0) instrument evaluates the effectiveness of mobility devices in assessing mobility-related participation, captured by three scales (Need for Assistance, Frequency, and Ease/Difficulty) and one index (Participation Repertoire).

Purpose.

This study aimed to investigate a range of psychometric properties of the NOMO 1.0 in a sample of adult powered mobility device (PMD) users.

Method.

Data collected from PMD users ( N = 248) in Denmark, Finland, and Norway as part of a larger study were analyzed using state-of-the-art statistical methods.

Findings.

The acceptability and applicability of the NOMO 1.0 items were generally within recommended values. Some floor/ceiling effects were found and the reliability was acceptable for only the Frequency scale. The factor analysis identified one component for the Need for Assistance scale and six components of the Frequency scale.

Implications.

The NOMO 1.0 should be used for research purposes and not for clinical practice. Better reliability should be established for the Need for Assistance and Ease/Difficulty scales prior to further psychometric testing to establish the validity of the NOMO 1.0.

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

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.

Effectiveness of Powered Mobility Devices in Enabling Community Mobility-Related Participation: A Prospective Study Among People With Mobility Restrictions

OBJECTIVE

To investigate the effectiveness of powered mobility device (ie, powered wheelchair and scooter) interventions over a 1-year period in Nordic countries.

DESIGN

Prospective design.

SETTING

The study involved community-dwelling participants from Denmark, Finland, and Norway.

PARTICIPANTS

In all, 180 participants with different self-reported impairments participated in the study. The mean age was 68.7 years (95% confidence interval [CI] = 39.9-97.5 years), and 47.8% of the participants were men.

METHODS

Two face-to-face interviews about mobility and mobility-related participation were conducted with participants in their homes. The first interview took place shortly before the participants received their powered mobility device, and the second took place about 1 year later (mean, 386.9 days; standard deviation = 52.78).

MAIN OUTCOME MEASURES

Changes in frequency, ease/difficulty, and number of mobility-related aspects of participation in daily life were investigated in the total sample and in subgroups by means of the NOMO 1.0 instrument, applying a structured interview format.

RESULTS

In the total sample, the frequency of shopping for groceries (P < .001, effect size = 0.29, 95% CI = 0.08-0.50) and going for a walk/ride (P < .001, effect size = 0.62, 95% CI = 0.41-83) increased, whereas the number of aspects of participation performed (P < .001) increased only slightly. Going to a restaurant/café/pub, shopping for groceries, doing other shopping, posting letters, going to the bank or the chemist's, going for a walk/ride, and visiting family/friends became easier (P < .001 to P = .001); effect sizes varied between 0.50 (95% CI = 0.29-0.71) and 0.85 (95% CI = 0.63-1.07). Men, persons who used scooters, and persons with poor self-reported health seem to benefit the most from the intervention.

CONCLUSIONS

Powered mobility device interventions mainly contribute to mobility-related participation by making participation easier for people with mobility restrictions and by increasing the frequency of aspects of participation such as shopping for groceries and going for a walk/ride. The effects varied with regard to the subgroups. The present study further strengthens the current evidence that powered mobility devices increase mobility-related participation in daily life among certain subgroups of adults with mobility restrictions.

Challenges of user-centred assistive technology provision in Australia: shopping without a prescription

PURPOSE

People with disability have a right to assistive technology devices and services, to support their inclusion and participation in society. User-centred approaches aim to address consumer dissatisfaction and sub-optimal outcomes from assistive technology (AT) provision, but make assumptions of consumer literacy and empowerment. Policy discourses about consumer choice prompt careful reflection, and this paper aims to provide a critical perspective on user involvement in assistive technology provision.

METHODS

User-centred approaches are considered, using literature to critically reflect on what user involvement means in AT provision. Challenges at the level of interactions between practitioners and consumers, and also the level of markets and policies are discussed, using examples from Australia.

RESULTS

There is no unanimous conceptual framework for user-centred practice. Power imbalances and differing perspectives between practitioners and consumers make it difficult for consumers to feel empowered. Online access to information and international suppliers has not surmounted information asymmetries for consumers or lifted the regulation of publicly funded AT devices.

CONCLUSIONS

Ensuring access and equity in the public provision of AT is challenging in an expanding market with diverse stakeholders. Consumers require personalised information and support to facilitate their involvement and choice in AT provision. Implications for Rehabilitation Variations in approaches informing AT provision practices have a profound impact on equity of access and outcomes for consumers. An internationalised and online market for AT devices is increasing the need for effective information provision strategies and services. Power imbalances between practitioners and consumers present barriers to the realisation of user-centred practice.

Test-retest reliability and agreement of the Satisfaction with the Assistive Technology Services (SATS) instrument in two Nordic countries

PURPOSE

The purpose of this study was to investigate test-retest reliability, agreement, internal consistency, and floor- and ceiling effects of the Danish and Finnish versions of the Satisfaction with the Assistive Technology Services (SATS) instrument among adult users of powered wheelchairs (PWCs) or powered scooters (scooters).

METHOD

Test-retest design, two telephone interviews 7-18 days apart of 40 informants, with mean age of 67.5 (SD 13.09) years in the Danish; and 54 informants with mean age of 55.6 (SD 12.09) years in the Finnish sample.

RESULTS

The intra-class correlation coefficient varied between 0.57 and 0.93 for items in the Danish and between 0.41 and 0.93 in the Finnish sample. The percentage agreement varied between 54.2 and 79.5 for items in the Danish and between 69.2 and 81.1 in the Finnish sample, while the Cronbach's alpha values varied between 0.87 and 0.96 in the two samples. A ceiling effect was found in all items of both samples.

CONCLUSIONS

This study indicates that the SATS may be reliably administered for telephone interviews among adult PWC and scooter users, and give information about aspects of the service delivery process for quality development improvement purposes. Further psychometric testing of the SATS is required.

Use, performance and features of mobile shower commodes: perspectives of adults with spinal cord injury and expert clinicians

PURPOSE

The purpose of this article is to explore the use of Mobile Shower Commodes (MSCs) by adults with Spinal Cord Injury (SCI) and to understand how adults with SCI and expert clinicians identify and select MSC designs and features.

METHOD

Semi-structured interviews were conducted with seven adults with SCI and eight expert clinical prescribers using semi-structured guides. Transcripts were analysed thematically using the Policy, Human, Activity, Assistance and Technology, and Environment (PHAATE) model as the underpinning theoretical framework.

RESULTS

Analysis of the interview transcripts revealed 3 themes and 12 sub-themes. The main themes were: (1) Activities, routines and interacting factors, (2) Features for functioning and (3) Getting it right. Substantial links existed between and across the themes and subthemes.

CONCLUSIONS

The use of MSCs by adults with SCI is complex. MSC performance varies across activities, and during interactions between the user, the MSC, other assistive technologies, assistance and physical environments. Future studies should explore service delivery processes and develop validated clinical assessment instruments and outcome measures for MSC provision. Implications for Rehabilitation Mobile shower commode use is complex, involving nine distinct activities and three types of routines. Mobile shower commodes used by Australian adults with SCI are individualised to users and include customisations and custom-made components. Trialling individualised mobile shower commodes prior to funding is problematic and not reflected in assistive service delivery models. Validated clinical instruments for assessing and selecting mobile shower commode features are needed.