1. Use, Non-Use, and Satisfaction with Assistive Technology Provided by a Reutilization Program Aimee Duplantis, OTS National AT Reuse Conference September 16, 2009

2. AT Reutilization Program for Independent Living Funded by: Rehabilitation Services Administration H235V060047

3. Purpose Determine rates of use and non-use of AT distributed by the AT Reutilization Program. Determine if and how reutilized AT is used. Identify factors that contribute to non-use. Evaluate participant satisfaction with program services.

4. Presentation Overview Describe the Assistive Technology (AT) Reutilization Program at Paraquad Results of follow-up interviews with past participants

5. Prevalence, Cost, and Benefits 16.6 million Americans use AT – 7.4 million with mobility impairments use AT Medicare expenditures – $7 billion for durable medical equipment (2007) – $1.5 billion for mobility related AT (2001) The use of AT has many benefits Carlson et al, 2001; Hoenig et al, 2001; Scherer & Glueckauf, 2005; Medicare Current Beneficiary Survey, 2001 & 2007; Russell et al, 1994

6. Barriers to AT Access Funding – Funding for AT acquisition is limited – Expensive and difficult to attain – 5 year interval – Back-up AT is not funded Services – Lack of information and evaluation – Insufficient follow-up – Added expense of repairs Recycling, Refurbishment, & Reutilization Programs Finlayson & Hammel, 2003; O’Day & Corocan, 1994

7. AT Reutilization Program for Independent Living – Collection of AT – Sanitization – Repair and refurbishment – Stored until sold – Significantly reduced price – Client is evaluated and participates in AT selection process and training

8. Method: Participants Inclusion Criteria Age 18 years or older Received AT at least 1 year prior – Mobility device Cane, crutch, walker, manual wheelchair, or power wheelchair – Shower chair or shower bench – Raised toilet seat or 3-in-1 commode Could answer survey questions

9. Demographics (N=40) Gender % Female70.0 Race % White47.5 African American/Black45.0 Other2.5 Income % $0-$14,999 57.5 $15,000-$34,99922.5 $35,000-$55,0005.0 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

10. Method: Semi-Structured Interview 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

11. AT Acquired from Program Device Type Total N=40 Mobility devicen=24 (60.0%) Shower chair or benchn=11 (27.5%) Raised toilet seat or 3-in-1 commode n=5 (12.5%)

12. 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%)

13. Price Comparison Reutilized AT Cost Mobility devices $3,090 Shower chairs and benches $260 Raised toilet seats and commodes $110 TOTAL$3,460 New AT Cost Mobility devices $34,680 Shower chairs and benches $760 Raised toilet seats and commodes $210 TOTAL$35,650

14. Data Analysis Procedures: Coding Transcribed interviews Grouped into use and non-use categories Used deductive content analysis Coded using the International Classification of Functioning, Disability, and Health (ICF) Hseih & Shannon, 2005; World Health Organization, 2001

15. International Classification of Functioning, Disability, and Health Functioning and Disability Body Functions and Structures Activities and Participation Contextual Factors Environmental Factors Personal Factors

16. 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 and relationships D8: Major life areas D9: Community, social, and civic life

17. D4: Mobility 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

18. “[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 What do you use your AT for?

19. “[My transfer bench] actually helps me transfer over into the tub or to take a shower… I don’t have to have more assistance getting into the tub and out…I don’t worry about falling off, or falling over.” Shower bench D4: Mobility - transferring oneself, maintaining a body position D5: Self-care - washing oneself

20. “[My raised toilet seat] helps me to be able to use the bathroom when I need to independently… It minimizes me having trying to hop up real far to get back in my chair” Raised toilet seat D4: Mobility - changing basic body position D5: Self-care - toileting

21. Without AT? Participation Restrictions “[My chair] doesn’t just help me. It makes it possible for me to do tasks.” Power wheelchair D4: Mobility, D6: Domestic life “Well it’s the only way I can bathe, so [the shower bench] is vital.” Transfer bench D5: Self-care

22. AT Use and Participation ICF Participation Domain Mobility device Shower chair or bench Raised toilet seat or commode D1: Learning and applying knowledge D2: General tasks and demands D3: Communication D4: Mobility D5: Self-care D6: Domestic life D7: Interpersonal interactions and relationships D8: Major life areas D9: Community, social, and civic life

23. Non-Use Participants Abandonment (n=6) Mobility device breakdown (n=3) Impairment change (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)

24. 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 [of health professionals] + E5: Services, systems, and policies +/- AT Program Evaluation

25. Discussion and Future Directions Evident need for this type of program – AT being distributed is not always medically necessary, but necessary for participation – Majority still use AT at follow-up Overall program and AT satisfaction Outcome Measures now implemented Policy to support AT reutilization programs

26. Questions? Comments? Carla Walker, Paraquad CIL – (314) 289-4301 – cwalker@paraquad.org Lindsey Bean, Paraquad CIL – (314) 289 - 4744 – Lbean@paraquad.org Kerri Morgan, Washington University in St. Louis – (314) 286 - 1659 – morgank@wusm.wustl.edu