AT REUSE STRAND Lindsey Kampwerth, OTD OTR/L Joy Kniskern, Principal Investigator Pass It On Center Research on AT Reuse Outcomes and Effectiveness Pass It On Center - AT Reuse Strand 1

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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

 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  Used for Program Evaluation and Continued Quality Assurance/Improvement  Indicate whether the effects of the program are what was intended (i.e.. improved community participation, independent living) WHY OUTCOMES? Abandonment Safety Effectiveness Appropriateness Program Evaluation Participation Consumer Feedback

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

Identify the research problem Review of literature: theoretical framework Identify variables State Hypotheses Specify purpose State Hypotheses Specify purpose Collect Data: Reduce data Collect Data: Reduce data Design the protocol Choose a sample Design the protocol Choose a sample Report findings Suggestions for further study Report findings Suggestions for further study Analyze Data Interpret findings PHASE I Identify the Research Question PHASE III Methods PHASE IV Data Analysis PHASE V Communication PHASE II Design the Study

Good fit between individual and environment Person with Impairment Person without Impairment 1. Functional Restoration Bad fit between individual and environment 2. Assistive Technology, Personal Assistance, and Environmental Modifications Institute of Medicine The Enabling - Disabling Process Brandt & Pope, 1997

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 surveysN= % Shower chair/benchn=3832.5% Raised toilet seat/commoden=1714.5% Mobility devicesn=6253.2%

Gender Female72.6% Race Black47.9% White47.0% Impairment Mobility93.2% Visual35.0% Mental Health29.9% Cognitive17.1% Hearing13.7% Income $0-$14, % Benefits Social Security84.6% Medicaid58.1% Medicare54.7% Age 28-93Mean 56.0 Currently Use Yes79.5%

FALLING (N=117) Have you fallen in the past month? n=116 Non=8169.2% Yesn=3529.9% Have falls limited participation in activities in the past month? n=35 Not at all20.0% A little25.7% A moderate amount34.3% A great deal20.0% Has the AT prevented you from falling? n=35 Never20.6% A little of the time5.9% Some of the time11.8% Most of the time26.5% All of the time35.3%

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How often do you use the AT from the program when…. moving around your home? Never15.5% Rarely13.8% Often25.9% Always44.8% leaving your home? Never15.5% Rarely13.8% Often25.9% Always44.8% doing leisure activities? Never17.0% Rarely20.8% Often32.1%) Always30.2%

Difficulty Average Least Difficult p<.001 *significant Most Difficult Without ATWith AT

PARTICIPANT DEMOGRAPHICS (N=40) Gender% Female70.0 Race% White47.5 Black45.0 Other2.5 Income% $0-$14, $15,000-$34, $35,000-$55, Not ascertained15.0 Age at purchase Mean58.0 Range28-91 Primary Impairment* % Mobility90.0 Visual30.0 Mental Health25.5 Cognitive12.5 Hearing12.5 *multiple choice question

 Use  Participation with reutilized AT  Level of difficulty without AT  Non-Use  Contributing factors Initial questions to determine use or non-use AT and Reutilization Program Satisfaction

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 benchn=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 devicen=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

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 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

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

“[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

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)

ICF Environmental Factor Facilitator or Barrier E1: Products and technology + E2: Natural environment and human- made changes to environment E3: Support and relationships + E4: Attitudes + E5: Services, systems, and policies +/- Program Evaluation

Kerri Morgan MSOT OTR/L ATP Lindsey Kampwerth OTD OTR/L

Pass It On Center - AT Reuse Strand 49 VATNet (Virginia Assistive Technology Network) The Business Case for AT Reuse In Virginia Outputs and Outcomes 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

Pass It On Center - AT Reuse Strand 50 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).

Pass It On Center - AT Reuse Strand 51 Calculation of Cost Savings Impact of VATNet ( ) Persons Served4,569 Gifted AT5,466 Saved Commonwealth$2,076,379 Outcomes Measures from Free Survey of 136 Virginian recipients of AT in 2006 OutcomeUnit CostSavings 26 hospital stays avoided Average Daily Cost =$1,149 x 5 days$149, ER Visitsits preventedAverage Cost =$1,896$54, Moves to Skilled Nursing Facility to Skilled Nursing Facility AvoidedAverage Annual Cost =$74,095$111,650 Estimated 50 day stay Average stay for discharged patients is 272 days 11 Moves to Assisted Living Facility AvoidedAverage Annual cost =$35,616$53,668 Estimated 50 day stay 112 Falls AvoidedAverage Cost of Drs. Visit =$155$4,340 Estimated 1 in 4 falls would result in drs. Visit 16 Job Losses AvoidedPoverty level income for family$91,573 of 3 in VA = $17, 170; 1/3 of cost estimated to be born by state. Total cost savings for each 100 recipients served$465,585 Total historical cost savings of serving 4,560 recipients$21,272.58

DISCLAIMER This work is supported under five-year cooperative agreement #H235V 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. Speaker contact Pass It On Center - AT Reuse Strand 52