printed by Research on Assistive Technology Reuse Outcomes and Effectiveness Lindsey Bean-Kampwerth, OTD, OTR/L, Joy Kniskern, Principal Investigator, Pass It On Center Contributors: Kerri Morgan, Carla Walker, Kim Walker, Aimee Duplantis, Melissa Najarian BEYOND OUTPUTS TO OUTCOMES  Outputs are raw data, such as numbers of device distributed or received.  Outcome is a level of performance, or achievement. For example, how did the device affect the persons participation in daily activities? 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 document unusual conditions or the effect of innovative interventions.  Surveys or Questionnaires are often used to collect descriptive information from small and large groups. 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. BACKGROUND The International Classification of Functioning, Disability, and Health (ICF) is formatted into two parts – functioning & disability and contextual factors. Functioning and disability are further separated into components called body functions and structures (this takes into account a person's strength or mobility). Activities and participation deal with the involvement in a life situation. Please see the diagram below. PURPOSE & AIMS The purpose of this study was to gather more information about people’s use & non- use of reused devices. METHODS Forty participants were contacted by telephone. Each participant had took part in a previous AT reuse study. While they were on the phone a semi-structured interview was completed. They were asked initial questions and then the remaining questions were open-ended. All of the interviews were transcribed and sorted into two groups; one group used their AT reuse device and the other had stopped using their reuse device. Transcription example is below. RESULTS [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 BACKGROUND The framework of this project was the Institute of Medicine’s Enabling-Disabling Process. When a person does not have an impairment there is a good interaction between the person and their physical, social and work environment. When the person has an impairment, the environment does not interact as well with the person and the person can not fully do their occupations. To improve the interaction between the person and environment there are two options that can be done together or individually. Option 1 is functional restoration. Functional restoration focuses on improving the person, such as increasing endurance, strength, or ROM. Option 2 is changing the environment by adding personal assistance, changing the physical environment or adding assistive technology, which is the focus of Assistive Technology Reuse. PURPOSE & AIMS The purpose of this 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. The specific aims were to develop an outcome measure to track the effectiveness of Paraquad’s AT Reutilization Program and to pilot the outcome measure with recipients of the program to examine if the consumer is using the AT they received from the program, if they are participating using the AT in Personal care and Community activities, and to finally examine the services of the program by finding gaps in the program and the satisfaction of the clients with the program. To do this the study had 3 phases. METHOD Phase one included item development for the AT reutilization survey. This included an extensive literature review and reviewing prior assessments. Phase two included qualitative research using focus groups. These groups were held to establish content validity of the survey items and how Paraquad’s participant reviewed the overall program. Phase three included a retrospective quantitative study using the AT reutilization survey. RESULTS The final survey consisted of The Characteristics of Respondents (CORE) which is used to collect demographic, such as income & benefits; The Participation Survey (PARTS/G) is used to measure the participation of people who use assistive technology. It has 20 activities that stand on their own because each has established internal consistency and test-retest reliability. (Gray, Hollingsworth, Stark, & Morgan, 2006); and The Quebec User of Evaluation of Satisfaction with Assistive Technology (QUEST) is a measurement of satisfaction with the AT device and services. (Demers, L., Monetti, M., Lapierre, Y., Arnold, D.L., & Wolfson, C., 2002) The focus group recommendations were to include items related to falling, specify questions are only about their AT reuse device, clarify the activity definitions and select activities that were relevant to AT use. The suggestions were used to improve the survey. The results of the final retrospective surveys included 34% of the 338 surveys being returned. The demographics are below. Approximately 80% were satisfied or highly satisfied with their AT reuse device and device services. Thirty five respondents said they have fallen in the past month. Of that, 35 people 34.3% and 20% said that falls limited their participation a moderate amount and a great deal. Then 26.5% of participants said that the AT prevented them from falling most of the time and 35.3% said all of the time. One question in the survey asked, “With the device you received from the program, the activity is____” then they could rank it on a likert scale, impossible to very easy. There was the same question except it asked “without the device you received from the program”. Taking the results from these two questions the means where measured, using a repeated measures t test to do this. There was statistical significance with AT and without AT for the 3 activities. See the graph below. Research is important to assistive technology reuse for a number of reasons. First, research directly influences the program and services, then in return the program and services directly influence the direction of the research. Second, research is helpful in getting funding and showing exactly how an Assistive Technology Reuse program helps a person. Third, research increases awareness and promotes the idea of Assistive Technology Reuse. Lastly, he research can also show how Reuse programs support the “Green Initiative”, which could be another possible funding store. BACKGROUND WHY IS RESEARCH SIGNIFICANT TO AT REUSE? QUANITATIVE AT REUSE RESEARCH EXAMPLEQUALITATIVE RESEARCH EXAMPLE International Classification of Functioning, Disability, and Health (IFC) Functioning & Disability Body Functions and Structures Activities and Participation Contextual Factors Environmental Factors Personal Factors 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 D4: MOBILITY 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 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% 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 III Methods PHASE IV Data Analysis PHASE V Communication PHASE II Design the Study PHASE I Identify the Research Question Foundations of Clinical Research: Application to Practice, Portney & Watkins Most Difficult Least Difficult Difficulty Average Without ATWith AT