Assessing the outcome of mobility assistive technology (OMAT) in daily living: results in an Italian sample.

BACKGROUND: Despite the widely recognised benefits of assistive technology (AT) in everyday life, AT abandonment rate due to unmet user needs or expectations is high. World Health Organisation emphasised the importance of evaluating AT outcomes as a top research priority, but comprehensive approaches to assess users' needs and AT impact are still limited. AIM: The research study OMAT (outcomes of mobility assistive technology in rehabilitation pathways) aimed to evaluate the feasibility of a new AT assessment protocol for mobility AT, spanning from an initial evaluation of users' and relatives' needs to a follow-up after real-world use of assistive products (APs). MATERIAL AND METHODS: An observational single-arm study involving 95 AT users was conducted at Fondazione Don Gnocchi (Milan, Italy). The OMAT protocol encompassed baseline assessment, user training, prescription, authorisation, delivery and follow-up. The evaluations blend standard clinical evaluations with validated AT outcome measures for perceived effectiveness of AT, user satisfaction and changes in quality of life. RESULTS: The feasibility of OMAT in clinical settings was established, with 67 user participants completing the protocol. Data showed positive impacts on user satisfaction and perceived AT effectiveness by all participants (users and relatives), with an improvement in the perceived degree of severity in problems. Quality of life outcomes, however, showed mixed results across various domains. CONCLUSION: OMAT is a feasible protocol for assessing mobility APs in clinical settings, underscoring the importance of involving users in the prescription process and the need for comprehensive AT monitoring mechanisms. This approach could enhance AT service delivery, exceeding the current standards of the Italian-National-Health-Service.Implication for rehabilitationPersonalise assistive technology (AT) based on user needs for higher effectiveness.Include structured follow-up in rehabilitation for better AT outcomes.Enhance patient involvement in AT selection to improve use.Focus on AT's role in enhancing overall quality of life.Use validated tools for AT impact assessment and monitoring.

The Rasch Analysis Shows Poor Construct Validity and Low Reliability of the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) Questionnaire.

This study aims to test the construct validity and reliability of the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 (QUEST)-device, an eight-item questionnaire for measuring satisfaction with assistive devices. We collected 250 questionnaires from 79 patients and 32 caregivers. One QUEST was completed for each assistive device. Five assistive device types were included. QUEST was tested with the Rasch analysis (Many-Facet Rating Scale Model: persons, items, and device type). Most patients were affected by neurological disabilities, and most questionnaires were about mobility devices. All items fitted the Rasch model (InfitMS range: 0.88-1.1; OutfitMS: 0.84-1.28). However, the ceiling effect of the questionnaire was large (15/111 participants totalled the maximum score), its targeting poor (respondents mean measure: 1.90 logits), and its reliability was 0.71. The device classes had different calibrations (range: -1.18 to 1.26 logits), and item 3 functioned differently in patients and caregivers. QUEST satisfaction measures have low reliability and weak construct validity. Lacking invariance, the QUEST total score is unsuitable for comparing the satisfaction levels of users of different device types. The differential item functioning suggests that the QUEST could also be problematic for comparing satisfaction in patients and caregivers.

Cost-effectiveness of powered wheelchairs: findings of a study.

This study surveyed a sample of 79 wheelchair users who had obtained powered wheelchairs from the National Health Service in an Italian Region in the period 2008-2013. The wheelchair prescriptions had been done on the basis of an assessment protocol agreed with the Local Health Authority. Follow-up interviews were carried out at the users' homes, in order to collect information about the wheelchair use and its effectiveness, usefulness and economic impact. The instruments used in the interviews included an introductory questionnaire (describing the wheelchair use), the QUEST (measuring the user's satisfaction), the PIADS (measuring the psychosocial impact, in terms of perceived changes in ability, adaptability and self-esteem), the FABS/M (detecting environmental facilitators and barriers) and the SCAI (estimating the economic impact). Overall, positive outcomes were detected for most users, especially in relation to their satisfaction and the psychosocial impact. A number of barriers were identified in various settings (at home, in public places, in natural spaces, in public transportation) that sometimes restrict the user mobility and thus may claim for corrective actions. Several environmental factors acting as facilitators were also identified. In relation to the economic impact, the provision of a powered wheelchair generated remarkable savings in social costs for most of the users, on average about 36.000 Euros per person on a projected 5-years span. This estimate results from the comparison between the social cost of the intervention (sum of the costs of all material and human resources involved in the provision and usage of the wheelchair) and the cost of non-intervention (the presumed social cost incurred in case no powered wheelchair had been provided and the user had to carry on with just a manual wheelchair). The study was also an opportunity to develop and try out a follow-up method that proved applicable within service delivery practice.