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– 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