Associations Between Insurance Provider and Assistive Technology Use for Computer and Electronic Devices 1 Year After Tetraplegia: Findings From the Spinal Cord Injury Model Systems National Database.

OBJECTIVE: To investigate the association between insurance provider and reported assistive technology (AT) use to access computers and electronic devices 1 year after sustaining tetraplegia. DESIGN: Multicenter cross-sectional study. SETTING: Participants enrolled in the Spinal Cord Injury Model Systems (SCIMS) National Database. INTERVENTIONS: Not applicable. PARTICIPANTS: Men and women with tetraplegia (N=498) enrolled in the SCIMS National Database were included in the analysis. MAIN OUTCOME MEASURES: The primary study outcome was the use of AT when operating a computer or other mobile electronic device. The primary predictor was the subject's principal health insurance provider, which was grouped into the 3 categories: government (Medicare, Medicaid, and other government), private (private insurance, private funds, and other), and workers' compensation. RESULTS: Overall, 34.7% of participants reported using AT to access computers and electronic devices. Results of logistic regression analysis revealed sex, injury level, injury completeness, self-perceived health status, and 12-month history of pressure ulcer were all significantly associated with AT use. After adjusting for these factors, participants with workers' compensation were more likely to report AT use than individuals with either government or private insurance. CONCLUSIONS: Despite significant technological advances, AT is not readily available to the people who might benefit most from its use. Findings from the present study are the first to shed light on AT funding sources and reveal that individuals with workers' compensation are more likely use AT than individuals with either government or private insurance. Additional work focused on AT use and functional outcomes is needed to assess the effect of barriers to use. Collectively, this work may inform insurers of the importance of having AT available for this unique population to potentially improve quality of life and participation.

Exploring systems-based practice in a sample of physical medicine and rehabilitation residency programs.

OBJECTIVE: This study explores physical medicine and rehabilitation (PM&R) residents' attitudes, knowledge, and perception of health care policy in the context of systems-based practice, one of the Accreditation Council for Graduate Medical Education's core competencies for residency training. DESIGN: A cross-sectional, observational design was used via survey administration. These surveys were categorized into 6 different sections: (1) general health care policy; (2) resident awareness of and involvement in policy matters; (3) specific policy pertaining to physical medicine and rehabilitation; (4) rehabilitation alternatives to acute care; (5) documentation; and (6) educational exposure. Residents filled the survey anonymously, noting only their postgraduate year and program name for identification. SETTING: This study was conducted at 3 large PM&R residency programs in Pennsylvania, New Jersey, and New York. PARTICIPANTS: Residents participating in this study totaled 32 from Program A, 26 from Program B, and 18 from Program C. METHODS: Residents at all 3 programs were asked to complete a 34-question survey. In total, 57 surveys were evaluated. The response rates for completing the entire survey for the 3 programs were 81% (26 of 32), 73% (19 of 26), and 67% (12 of 18). The overall response rate was 75%. Not all residents at each program were given surveys to complete. MAIN OUTCOME MEASURES: This study explored resident's attitudes, knowledge, and perception of healthcare policy. Outcomes included understanding how residents feel about the extent of their general policy education, their awareness of current issues and the organizational entities that shape these policies, and whether they should be exposed to these topics within the setting of their training programs. Responses were measured on a 1 (strongly disagree) to 9 (strongly agree) scale. Specific paired t-tests were performed on select questions to further validate the responses. RESULTS: Residents uniformly agree that healthcare policy is an important aspect of medical education and should be taught within their residency programs but do not feel that they currently play an active role in affecting change (8.1 +/- 0.8 vs. 3.4 +/- 1.6, P < .001). They admit to not being aware of how to get involved but would like to delve more into these issues (3.9 +/- 1.5 vs. 7.1 +/- 1.5, P = .01). Pertaining to PM&R-specific policy, residents believe that functional ability trumps diagnosis as the most important determinant for admission to an acute inpatient facility (7.5 +/- 1.2 vs. 5.9 +/- 1.8, P < .001). Although residents see the importance of documentation, they indicate they are not adequately trained in this area (8.2 +/- 0.7 vs. 3.9 +/- 1.1, P = .04). Finally, residents acknowledge they have limited understanding of other rehabilitation delivery options or insurance companies (5.5 +/- 1.2 and 3.5 +/- 1.7). CONCLUSION: Systems-based practice is a core requirement of residency training yet has not been extensively studied. This study suggests that residents find systems-based issues important to their overall education but are not sufficiently or effectively addressed in residency. The healthcare delivery environment including PM&R is rapidly changing. It is imperative that residents are equipped with the knowledge of and ability to adapt to these changes.

Evaluation of the ES-2re Dummy in Biofidelity, Component, and Full Vehicle Crash Tests.

This technical paper presents the results from tests conducted with the ES-2re, a version of the ES-2 side impact dummy that was modified by the National Highway Traffic Safety Administration (NHTSA) to improve its performance in crash tests. Through the series of biofidelity tests conducted on the ES-2re, described in International Standards Organization (ISO) Technical Report (TR)9790 (1999), the OSRP observed a final overall biofidelity ranking of 4.1 for the ES-2re, which corresponds to an ISO classification of "marginal." The biofidelity of the ES-2re is compared to that of the ES-2 and the WorldSID. Repeatability was also evaluated on the ES-2re based on the biofidelity test data. Additional pendulum tests were performed to assess the response of the dummy in oblique loading conditions, and results indicate that oblique loading from the front leads to significantly reduced rib deflections. To evaluate inconsistencies observed in the response of the ES-2, the OSRP analyzed the shoulder biofidelity via additional sled and drop tests. Due to the shoulder design of the ES-2 and ES-2re, the dummies appear to have significant sensitivity to initial conditions, potentially increasing variability in full vehicle tests. Finally, the responses of the ES-2re in full vehicle tests are compared to those of the ES-2 and the WorldSID.

ES-2 Dummy Biomechanical Responses.

This technical paper presents the results of biomechanical testing conducted on the ES-2 dummy by the Occupant Safety Research Partnership and Transport Canada. The ES-2 is a production dummy, based on the EuroSID-1 dummy, that was modified to further improve testing capabilities as recommended by users of the EuroSID-1 dummy. Biomechanical response data were obtained by completing a series of drop, pendulum, and sled tests that are outlined in the International Organization of Standardization Technical Report 9790 that describes biofidelity requirements for the midsize adult male side impact dummy. A few of the biofidelity tests were conducted on both sides of the dummy to evaluate the symmetry of its responses. Full vehicle crash tests were conducted to verify if the changes in the EuroSID-1, resulting in the ES-2 design, did improve the dummy's testing capability. In addition to the biofidelity testing, the ES-2 dummy repeatability, reproducibility and durability are discussed. Finally, this technical paper will compare the biofidelity ratings of the current adult side impact dummies with the ES-2 dummy, which received an overall dummy biofidelity rating of 4.6.