Use, Non-Use, and Satisfaction with Assistive Technology Provided by a
Reutilization Program
Aimee Duplantis, OTSNational AT Reuse Conference
September 16, 2009
AT Reutilization Program for Independent Living
Funded by:Rehabilitation Services Administration
H235V060047
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.
Presentation Overview
• Describe the Assistive Technology (AT) Reutilization Program at Paraquad
• Results of follow-up interviews with past participants
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
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
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
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
Demographics (N=40)
Gender %
Female 70.0
Race %
White 47.5
African American/Black 45.0
Other 2.5
Income %
$0-$14,999 57.5
$15,000-$34,999 22.5
$35,000-$55,000 5.0
Not ascertained 15.0
Age at purchaseMean 58.0
Range 28-91
Primary Impairment* %
Mobility 90.0
Visual 30.0
Mental Health 25.5
Cognitive 12.5
Hearing 12.5
*multiple choice question
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
AT Acquired from Program
Device Type TotalN=40
Mobility device n=24 (60.0%)
Shower chair or bench n=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 Usen=32
Non-Usen=8
Mobility device n=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%)
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
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
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
D4: MobilityCodes
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 equipmentMoving 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
“[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 userD4: Mobility - moving with ATD6: Domestic life - acquisition of goods and servicesD9: Community, social and civic life - religion and spirituality
What do you use your AT for?
“[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
“[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
Without AT?Participation Restrictions
“[My chair] doesn’t just help me. It makes it possible for me to do tasks.”
Power wheelchairD4: Mobility, D6: Domestic life
“Well it’s the only way I can bathe, so [the shower bench] is vital.”
Transfer benchD5: Self-care
AT Use and ParticipationICF Participation Domain Mobility
deviceShower chair
or benchRaised 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 •
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)
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
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
Questions? Comments?Carla Walker, Paraquad CIL
– (314) 289-4301– [email protected]
Lindsey Bean, Paraquad CIL– (314) 289 - 4744– [email protected]
Kerri Morgan, Washington University in St. Louis– (314) 286 - 1659– [email protected]
Top Related