Abandonment of assistive products: assessing abandonment levels and factors that impact on it

Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center.

Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews.

Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels.

Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery.

• Implications for Rehabilitation

• Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings.

• The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users.

• The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels.

• As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.

     

重症监护病房患者睡眠质量的评价及影响因素

住院患者均存在不同程度的睡眠障碍,重症监护病房（intensive care unit,ICU）患者的睡眠障碍尤为突出。Nelson等报道,睡眠障碍是ICU患者最常见的主诉之一,也是导致患者应激的第2位常见原因。Simini对出院后3d的ICU患者进行随访,结果显示61％的患者在ICU期间存在睡眠剥夺,7％的患者存在失眠;即使出院3个月后,仍有44％的患者持续存在睡眠障碍。     

Occupational Therapists' Experience with Assistive Technology in Provision of Service to Clients with Alzheimer's Disease and Related Dementias

ABSTRACT

Aims: The objective of this study was to determine how occupational therapy practitioners use assistive technology (AT) when treating clients who have Alzheimer's disease and related dementia (ADRD). Methods: This study utilized a qualitative phenomenological approach in which occupational therapy practitioners were individually interviewed to explore their use of AT with clients who have ADRD. Results: Findings suggest that some assistive technology devices work better for clients at different stages. Clients in the earlier stages of dementia can use a broader range of assistive technology devices, while those in the later stages may not have the ability to use intricate assistive devices. It was also found that assistive technology is primarily used to address safety concerns with the ADRD population. These concerns include elopement, fall prevention, kitchen safety, and medication management. Three main themes were identified in the current study, including Education (for both the client and their family members/caregivers), Safety, and Selection Process. Conclusions: When using AT, occupational therapy practitioners must consider the stage of dementia their client is in, as well as the client's performance skills. Client safety and education were emphasized as key elements of the occupational therapy process.     

辅助器具及服务模式的发展动态

文中简要回顾了辅助器具从单件制作到批量生产再到大规模产业的形成过程,介绍了国际上对辅助器具、无障碍环境以及辅助技术服务的最新认识,对我国辅具行业提出了两点建议:搞好社区康复中辅助器具工作,使普通型辅具进家庭、进社区;培养一大批能从事辅助技术服务的专业人才并构建覆盖全国的辅助技术服务体系。     

国际辅助技术服务的政策架构、核心内容和发展研究

目的 研究联合国和世界卫生组织(WHO)辅助技术服务的政策架构与核心内容,比较不同经济发展水平国家辅助技术发展现状,探讨未来辅助技术政策与服务发展。方法 基于联合国和WHO辅助技术的相关政策与理论架构,运用WHO健康服务体系构成要素的理论,分析国际辅助技术服务的政策架构与主要内容,比较全球不同经济发展水平国家辅助技术服务政策、辅助产品和服务发展,探讨国际辅助技术的政策与创新技术发展热点。结果 辅助技术服务是康复服务的重要组成部分,发展辅助技术服务是实现联合国可持续发展目标三“确保健康的生活方式,促进各年龄段人群的福祉”的关键步骤。联合国和WHO发布的辅助技术服务相关指南提供了辅助技术服务政策,其核心架构是基于联合国《残疾人权利公约》有关辅助技术内容,并具体表现在WHO《世界残疾报告》《全球残疾行动计划》《健康服务体系中的康复》和《健康服务体系中的康复：行动指南》以及WHA 71.8号有关辅助技术的决议《改善获得辅助技术的机会》等核心文件中。国际辅助技术政策核心内容旨在构建以人为本的综合保健服务,强调将辅助技术纳入公共卫生医疗体系和康复服务范畴,根据WHO健康服务的六大核心构成要素建立和发展辅助技术服务,从而提高获取优质辅助技术机会,以实现全民健康覆盖,并且在辅助产品和辅助技术服务领域,倡导技术和服务创新,形成5P辅助技术模式。高收入国家和中低收入国家在辅助技术服务政策、辅助技术产品提供以及服务覆盖率方面都面临诸多困难,存在着较大差异。未来各国辅助技术发展热点主要是采用WHO提出的5P模式进行政策和服务提供以及技术变革,辅助技术产品开发、辅助技术服务模式的创新将是未来发展的热点。结论 国际社会有关辅助技术的政策是以联合国《残疾人权利公约》为核心,并以联合国及WHO发表的辅助技术服务的相关政策文件为基础形成的,其主旨在于发展辅助技术服务,为残疾人、老年人和其他功能障碍者提供及时、适当和可负担的辅助技术服务,改善他们的健康并提升生活质量和福祉。要将辅助技术纳入全民健康覆盖,并通过初级卫生保健加强服务提供,以实现联合国可持续发展目标三全民健康覆盖的目标,实现辅助技术服务全覆盖。发展辅助技术,要将辅助技术纳入康复服务的范畴,在WHO健康服务体系的六大构成要素架构下,完善辅助技术服务的治理,通过多种机制为辅助技术服务进行筹资,培训康复人才从事辅助技术工作,改善辅助技术的服务提供,提升服务的质量,将辅助技术纳入基本医药技术,建立适应辅助技术发展的健康信息系统并对辅助技术服务提供监测。在世界不同地区,由于经济和社会发展水平的差异,辅助产品和技术服务的发展水平存在着很大差异,在获得辅助技术服务时遇到很大挑战。需要制定相关的政策、规划,并进行技术和服务创新。未来辅助技术发展将围绕辅助技术的5P模式进行产品和服务提供领域的改革以及技术创新,以提升辅助技术服务的覆盖率、有效性、可及性和可负担性,在全民健康覆盖架构下,将辅助技术服务融入健康服务体系,实现全民辅助技术服务全覆盖,提升辅助技术服务的质量和辅助技术消费者的福祉。     

Migraine Education Improves Quality of Life in a Primary Care Setting

(Headache 2010;50:600‐612) Objective.— The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine‐related disability and quality of life, worry about headaches, self‐efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care. Background.— Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self‐efficacy for managing headaches, worry about headaches). Methods.— In this open‐label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills‐based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache‐related disability (as measured by the Headache Impact Test‐6 (HIT‐6), migraine‐specific quality of life (MSQ), worry about headaches, self‐efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months). Results.— Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT‐6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in “worry about headaches,”“self‐efficacy for managing headaches,” and “satisfaction with headache care.” Conclusion.— The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache.     

Enhancing Mobile Phones for People With Visual Impairments Through Haptic Icons: The Effect of Learning Processes

We report the results of a study on the learnability of haptic icons used in a system for incoming-call identification in mobile phones. The aim was to explore the feasibility of using haptic icons to create new assistive technologies for people with visual impairments. We compared the performance and satisfaction of users with different visual capacities (visually impaired vs. sighted) and using different learning processes (unimodal vs. multimodal). A better recognition rate and user experience were observed for the visually impaired than for sighted users and for multimodal rather than unimodal learning processes.     

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

Abstract

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 rehabilitation

• Assistive 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.

     

The Relationship between Patients' Perceptions of Team Effectiveness and their Care Experience in the Emergency Department

Background

Effective teamwork is important in the fast-paced Emergency Department (ED) setting. Most of the teamwork literature addresses the provider's perspective of teamwork rather than the patient's perspective.

Objective

Examine the relationship between patients' perceptions of teamwork and care experience in the ED.

Methods

We conducted a cross-sectional survey study of adult patients seen at the University of Pennsylvania ED during the fall of 2011. Patients rated overall satisfaction, pain management, trust, and confidence in the team and likelihood of treatment compliance (outcomes) and four components of team effectiveness (role clarity, shared goals, relationships, and job satisfaction) on a Likert scale. We examined the relationship between patients' perception of teamwork and the outcomes using multivariate analysis, controlling for sociodemographic factors.

Results

We collected 1010 surveys. Patients rated the individual components of teamwork equally, with about 70% rating teamwork as “Very High.” Most patients who rated teamwork highly also rated their confidence and trust in their providers highly (80–90%) compared to 20% of those who rated teamwork lower. The relative risk ratios between high and low teamwork were 4.1 (95% confidence interval [CI] 2.8–5.9) for overall satisfaction, 3.9 (95% CI 2.7–5.8) for satisfaction with pain treatment, 5.3 (95% CI 3.6–7.8) for confidence in providers, and 1.9 (95% CI 1.5–2.5) for likelihood to follow-up treatment recommendations.

Conclusions

Patient satisfaction and willingness to adhere to treatment recommendations are highly correlated with patients' perceptions of ED teamwork.     

Are there differences in factors influencing access and continued use of assistive products for people with intellectual disabilities living in group homes?

Abstract

Background: The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE) to implement those parts of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) referring to assistive technology and products. A particular vulnerable group deeply affected by health inequity affecting access to assistive products are people with intellectual disabilities.

Objective: The objective of this study is to understand the barriers and facilitators to effectively access and continuously use essential assistive products for people with intellectual disabilities.

Materials and methods: Face-to-face interviews with 15 adults with a mild to profound intellectual disability and 15 providers of assistive products were conducted to gain insights about current use, needs, knowledge, awareness, access, customization, funding, follow-up, social inclusion, stigma and policies around assistive products and intellectual disability. The technique of constant comparative analysis was used to analyze the data.

Results and conclusion: An overview of factors is presented that fit within seven domains for access and eight domains for continuous use of assistive products for people with intellectual disabilities. It illustrates that access and continuous use are influenced by different barriers and facilitators. These different influences should be taken into account in country policies and frameworks that seek to implement the UNCRPD through assistive technology.

• Implications for rehabilitation

• Proactive assessment for assistive products by health professionals is rare and the vast majority of people with intellectual disabilities depend on carers to signal the need .

• A lack of education for carers around available assistive products and the benefits of assistive products for people with intellectual disabilities may lead to an underutilization for this group.

• The paternalistic attitude of care providers towards people with intellectual disabilities limits access and use to certain (high-tech) assistive products.

• The segmented and disjointed aspect of public funding to support assistive products found in this study is a key issue for policymakers who aspire to adhere to implementing the UNCRPD equally in all areas of their country.

     

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.     

The effects of two assistive technologies on reading comprehension accuracy and rate

ABSTRACT

This study compared the effectiveness of two assistive technologies to accommodate the word reading skills of four middle school students with reading learning disabilities. Kurzweil 3000 is a continuous text-to-speech (TTS) computer software program that allows students to follow along on a computer monitor while passages are read aloud. A reading pen is a discontinuous TTS assistive technology (AT) device that allows students to scan and hear selected words read aloud. An adapted alternating treatments design was implemented to compare the effects of listening-while-reading using continuous TTS AT, discontinuous TTS AT, and silently reading without accommodation on reading comprehension accuracy and rate. Results indicate that in three of the four participants, continuous TTS technology led to the greatest improvements in both comprehension accuracy and rate when compared to silent reading with effect sizes reaching 0.70 and 0.99, respectively. The fourth participant demonstrated the highest comprehension accuracy and rate in the discontinuous TTS condition. The discontinuous TTS condition led to the lowest comprehension rates across all four students. Additionally, participants generally found the continuous TTS AT to be the more acceptable of the two accommodations. Discussion focuses on possible theoretical explanations for the results and implications for future research.     

Techniques and Recommendations for the Inclusion of Users with Autism in the Design of Assistive Technologies

ABSTRACT

The increasing numbers of technology platforms offer opportunities to develop new visual assistive aids for people with autism. However, their involvement in the design of such aids is critical to their short-term uptake and longer term use. Using a three-round Delphi study involving seven Australian psychologists specializing in treating people with autism, the authors explored the utility of four techniques that might be implemented to involve users with autism in the design process. The authors found that individual users from the target group would be likely to respond differently to the techniques and that no technique was clearly better than any other. Recommendations for using these techniques to involve individuals with autism in the design of assistive technologies are suggested.     

澳大利亚残疾人辅助技术服务政策与发展研究

目的 探讨澳大利亚残疾流行率、辅助技术服务的需求、服务政策、服务体系.方法 参照世界卫生组织《健康服务体系中的康复》相关政策建议和指标清单,通过内容分析和发展研究的方法,分析澳大利亚辅助技术服务的政策架构、服务发展以及未来发展趋势.结果 澳大利亚统计残疾人约440万,其中重度或极重度残疾人140万(32％);澳大利亚联...     

Baby boomers' use and perception of recommended assistive technology: A systematic review

Purpose.?The objective of this article is to review published studies to describe issues and quality of evidence surrounding assistive technology (AT) use by the baby boomer generation. As the baby boomer generation are ageing, they represent a new era for aged health care. In terms of helping this generation maintain independence, it is expected that there will be an increased demand for AT.

Method.?A systematic literature search of Medline, CINAHL and Cochrane was undertaken. Selected studies were critically appraised using a previously validated tool. Inclusion criteria were: research related to AT use by a population which includes baby boomers; published in peer-reviewed journals and full-text English language articles. Studies were based in acute rehabilitation units in the USA and Australia. Frequency of use and patient satisfaction surveys were the main outcome measures.

Results.?A total of 11 eligible studies were reviewed. All were cross-sectional. Many studies indicated a significant rate of AT non-use; use rates ranged from 35% to 86.5%. Numerous factors influencing use were proposed. Study quality was upper-mid range.

Conclusions.?Baby boomers will place more demand on AT in the future. There is a need for high-quality research to verify current findings and highlight AT issues specific to this generation.     

Assistive technology needs,functional difficulties,and services utilization and coordination of children with developmental disabilities in the United States

Assistive technology (AT) enhances the ability of individuals with disabilities to be fully engaged in activities at home, at school, and within their communities—especially for children with developmental disabilities (DD) with physical, sensory, learning, and/or communication impairments. The prevalence of children with DD in the United States has risen from 12.84% in 1997 to 15.04% in 2008. Thus, it is important to monitor the status of their AT needs, functional difficulties, services utilization, and coordination.

Using data from the 2009–2010 National Survey on Children with Special Health Care Needs (NS-CSHCN), we conducted bivariate and multivariate statistical analysis, which found that 90% or more of parents of both children with DD and other CSHCN reported that their child’s AT needs were met for vision, hearing, mobility, communication, and durable medical equipment; furthermore, children with DD had lower odds of AT needs met for vision and hearing and increased odds for meeting AT needs in mobility and communication.

Our findings outline the current AT needs of children with DD nationally. Fulfilling these needs has the potential to engender positive lifelong effects on the child’s disabilities, sense of independence, self-confidence, and productivity.     

The development and evaluation of a web-based programme to support problem-solving skills following brain injury

Background and aim: Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury.

Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study.

Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions.

Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury.

• Implications for Rehabilitation

• People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts.

• Research supports problem solving skills training following brain injury.

• Assistive technology for cognition (smartphones, selected apps) offers a means of

• supporting problem solving for this population.

• This project demonstrated the feasibility of a web-based programme to address this need.

     

康复工程和辅助技术的发展历程、内涵和理论基础

简要介绍康复工程和辅助技术的内涵和发展历程及其理论基础,阐述了康复工程和辅助技术的定义、学科定位及其相互关系。