Assistive Technology Use and Provision During COVID-19: Results From a Rapid Global Survey.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted all segments of society, but it has posed particular challenges for the inclusion of persons with disabilities, those with chronic illness and older people regarding their participation in daily life. These groups often benefit from assistive technology (AT) and so it is important to understand how use of AT may be affected by or may help to mitigate the impacts of COVID-19. Objective: The objectives of this study were to explore the how AT use and provision have been affected during the initial stages of the COVID-19 pandemic, and how AT policies and systems may be made more resilient based on lessons learned during this global crisis. METHODS: This study was a rapid, international online qualitative survey in the 6 United Nations (UN) languages (English, French, Spanish, Russian, Arabic, Mandarin Chinese) facilitated by extant World Health Organization (WHO) and International Disability Alliance networks. Themes and subthemes of the qualitative responses were identified using Braun and Clarke's 6-phase analysis. RESULTS: Four primary themes were identified in in the data: Disruption of Services, Insufficient Emergency Preparedness, Limitations in Existing Technology, and Inadequate Policies and Systems. Subthemes were identified within each theme, including subthemes related to developing resilience in AT systems, based on learning from the pandemic. CONCLUSION: COVID-19 has disrupted the delivery of AT services, primarily due to infection control measures resulting in lack of provider availability and diminished one-to-one services. This study identified a need for stronger user-centred development of funding policies and infrastructures that are more sustainable and resilient, best practices for remote service delivery, robust and accessible tools and systems, and increased capacity of clients, caregivers, and clinicians to respond to pandemic and other crisis situations.

Preliminary steps of the development of a Minimum Uniform Dataset applicable to the international wheelchair sector.

Assistive products outcomes are needed globally to inform policy, practice, and drive investment. The International Society of Wheelchair Professionals developed a Minimum Uniform Dataset (MUD) for wheelchair services worldwide with the intent to gather data that is comparable globally. The MUD was developed with the participation of members from around the globe and its feasibility piloted at 3 sites. Three versions of the MUD are now available-a short form with 29 data points (available in English, Spanish, and French) and a standard version with 38 data points in English. Future work is to validate and complete the translation cycles followed by promoting the use of the MUD globally so that the data can be leveraged to inform policy, practice and direct investments.

Factors that influence the use of community assets by people with physical disabilities: results of participatory mapping in Envigado, Colombia.

BACKGROUND: Disability is an evolving concept that results from the complex interaction between a person with an impairment and the context in which he/she lives. There is limited understanding on the types, access and use of community assets valuable for people with disabilities, and the role of contextual factors in Colombia. Our goal with this work was to identify the factors at the levels of the socio-ecological framework, and their interaction, that influence the use of community assets among people with physical disabilities and community stakeholders in Envigado, Colombia. METHODS: Using participatory mapping, a community based participatory approach, we carried out an assessment of community assets identified by people with disabilities and rehabilitation professionals. In-depth interviews (n = 32) informed the design of two participatory mapping activities, one among people with disabilities (n = 5) and a second with rehabilitation professionals (n = 4). Results were presented in a community forum to receive feedback on the findings. RESULTS: Main findings indicate a chain of contextual factors that limit access and use of assets stemming from the personal (e.g. financial resources, inaccessible housing), interpersonal level (e.g. lack of a personal assistance or aid), and community levels (e.g. lack of accessible public transportation and inaccessible buildings). In most cases these barriers are heightened by system level barriers (e.g. lack of effective enforcement of the legal framework). CONCLUSIONS: Identifying these contextual factors, and their interactions, calls for stronger enforcement of the existing legal framework through articulated work between different stakeholders, so that people with disabilities can enjoy community assets.

Undergraduate physiotherapy students' basic wheelchair provision knowledge: a pilot study in two universities in Colombia.

Purpose: Access to an appropriate wheelchair is a human right. Only between 5-15% of people who need a wheelchair have access to one. One of the key barriers to access is the lack of appropriately trained rehabilitation professionals. The objective of this study was to evaluate basic manual wheelchair provision knowledge in final-year physiotherapy undergraduate students in two programs in Colombia.Materials and methods: Students took the International Society of Wheelchair Professionals Wheelchair Service Provision - Basic Test which was administered online and in Spanish. The minimum score to pass the test is 70%; it assesses seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process.Results and conclusions: One-hundred sixteen students took the test and no one passed the test. The highest median domain scores were in Assessment and Process while the lowest were in Fitting and Products. The limitations of this study include that this sample does not represent all physiotherapy programmes or students in Colombia, there may be potential errors in the Spanish translation of the outcome measure, and students encountered Internet connectivity issues during the test that may have impacted their scores. Immediate interventions are required to improve teaching and students' learning outcomes related to basic manual wheelchair provision in these two programs. This study may serve as a foundation for future regional or national studies that assess the situation of wheelchair provision training in rehabilitation programs that will inform improvement actions. This manuscript is also available in Spanish as Supplemental Material.Implications for rehabilitationThis study indicates that students' current knowledge on basic appropriate manual wheelchair provision from two physiotherapy programs in Colombia is insufficient. Students' knowledge does not align with the minimum guidelines recommended for wheelchair service provision by the World Health Organization.Objectively identifying the gap in knowledge in rehabilitation trainees (i.e., physiotherapy students) is a strategy to promote the inclusion of assistive technology related content in formal academic training.The need to include formal training of appropriate wheelchair provision persists and without this training, people with disabilities who require a wheelchair for mobility will continue to face barriers to full participation in society.

Personas con discapacidad, salud laboral y capacidades en las leyes del 2011-2020 / People with disabilities, occupational health and capacities in laws from 2011-2020 / Pessoas com deficiência, saúde do trabalhador e capacidades nas leis de 2011-2020

Objetivo: Identificar los conceptos de capacidades en las leyes relacionadas con la salud laboral para las personas con discapacidad en Colombia entre el 2011 y 2019. Materiales y método: Cualitativo con un enfoque metodológico es el hermenéutico-comprensivo a través de un análisis de contenido. Resultados: El estudio evidenció algunos conceptos de capacidades relacionados con las posibilidades que tienen las personas con discapacidad de elegir funcionamientos valiosos para su vida sin embargo las normas siguen presentando vacíos en cuanto a la definición de capacidad y una orientación hacia los funcionamientos que no permiten a las personas con discapacidad desarrollar sus capacidades. Conclusiones: Desde la perspectiva de la salud pública, son claras las desigualdades que pretenden solucionar las normas, pero puede afirmarse que, desde lo legislativo, las capacidades son abordadas desde conceptos muy generales y con elementos básicos respecto al desarrollo de capacidades de las personas con discapacidad y por lo tanto la posibilidad de evitar la discriminación de esta población en los entornos laborales sigue siendo un reto de cara a la práctica y la inclusión social

Objective: Identify the concepts of capacities in laws related to occupational health for people with disabilities in Colombia, between 2011 and 2020. Materials and methods: Qualitative study with hermeneutic-comprehensive methodological approach through the analysis of the content. The tracking of information was made through the annual reports from the Congress of Colombia found in digital archives denominated gazettes, issued between 2011- 2020. Law 361 of 1997, which regulates the reinforced labor stability was also included. For the processing of information, the 8th version of the program Atlas/Ti was used. The categories for analysis that were considered were: health, work, employment, labor disability, and capacities. Results: The study showed some capacity concepts related to the possibilities of people with disabilities of choosing valuable functions for their life: however, laws keep presenting voids regarding the definition of capacity and an orientation towards working operations that do not allow people with disabilities to develop their skills. Conclusions: From the public health standpoint, the inequalities that the laws pretend to solve are clear; but it can be claimed, from a legislative perspective, that the capacities are addressed from very general concepts and with basic elements. On the other hand, regarding the development of skills in people with disabilities and the possibility of avoiding discrimination for this population in work environments, it remains a challenge for practice and social inclusion.

Objetivo: Identificar os conceitos de capacidades nas leis relacionadas com a saúde do trabalhador para as pessoas com deficiência na Colômbia, entre 2011 e 2020. Métodos: Estudo qualitativo com metodologia hermenêutico-compreensiva na análise de conteúdo. A procura da informação realizou-se através dos anais do Congresso da República que repousam em arquivos digitais nomeados "gacetas", produzidos desde 2011 a 2020. Para o processamento da informação empregou-se o software Atlas/Ti, versão 8. As categorias na análise foram: saúde, trabalho, emprego, deficiência laboral e capacidades. Resultados: O estudo evidenciou alguns conceitos de capacidades relacionados com as possibilidades que tem as pessoas com deficiência de escolher funcionamentos de valor para as suas vidas; entretanto, as normas continuam apresentando vazios na definição de capacidade e à orientação aos funcionamentos, impedindo que às pessoas com deficiência desenvolver as suas capacidades. Conclusões: Na perspectiva de saúde pública, são claras as desigualdades que pretendem solucionar com as normas, porém desde a legislação, as capacidades são definidas com conceitos superficiais e básicos. Por outro lado, em relação com desenvolvimento de capacidades nas pessoas com deficiência e a possibilidade de evitar a discriminação e preconceito no ambiente de trabalho, continua sendo um desafio de cara à prática e à inclusão social.

Appropriate Assistive Technology for Developing Countries.

Access to appropriate and affordable assistive technology is a human right, and a public health and development priority. This article elaborates on these aspects and illustrates the various opportunities and barriers to achieving equitable access to assistive technology through 4 specific country snapshots. In Brazil, mobility aids are provided through universal health coverage in rehabilitation reference centers in urban areas. A community-based rehabilitation pilot project in Argentina demonstrates how to reach an excluded indigenous community. A rapidly developing national legal framework in Colombia with imminent implementation challenges is showcased, as is a technology transfer model in India.

Experiences with rehabilitation and impact on community participation among adults with physical disability in Colombia: perspectives from stakeholders using a community based research approach.

BACKGROUND: Despite representing 70 million people in Latin America, access to comprehensive rehabilitation and participation in the community remains a challenge for persons with disability (PWDs) in the region. Through enactment of the Disability Law, Colombia has made improvements to recognize and address some of the barriers for PWDs, including access to comprehensive rehabilitation. However access remains limited with significant disconnect between perspectives of various stakeholders and the needs of the population. We examined the unique perceptions on access to comprehensive rehabilitation services and participation of PWDs. We also explored the perspective of caregivers of PWDs, rehabilitation professionals, and other stakeholders on the experiences of PWDs. Our goal was to identify gaps in the implementation of comprehensive rehabilitation programs, and barriers to access resources for comprehensive rehabilitation or services that would impact participation of PWDs. METHODS: Qualitative study conducted in 2017. Data was collected from a purposive sample of adults with physical disability, aged 18-44 years, who had received rehabilitation services at a local partner organization and with different backgrounds and experiences with disability. Purposive sampling was also conducted with caregivers, rehabilitation professionals, and other stakeholders. Socio-demographic information was collected and semi-structured interviews were conducted by a research team member, recorded, transcribed and analyzed using a thematic analysis method to identify main themes related to our aim. CES University ethical review board approved this study. RESULTS: Thirty-two participants were interviewed: eight were male, 42.1 ± 11.1 years old, and 44% (n = 14) were PWDs. Three main themes were identified among all the participants: the meaning of rehabilitation, challenges to access services, and participation. Challenges to access services had three sub-themes: barriers to personal mobility, perceptions and knowledge on disability, and navigating the system. CONCLUSION: The main focus of rehabilitation as perceived by stakeholders is still on functional rehabilitation. If healthcare personnel is better trained on disability and if those with disabilities are actively involved in the developing these programs, the focus may evolve to a comprehensive and equitable rehabilitation process that fosters full participation.

Implementation of the hybrid course on basic wheelchair service provision for Colombian wheelchair service providers.

INTRODUCTION: People with mobility impairments often rely on wheelchairs as their primary means of mobility. Untrained wheelchair service providers may provide inappropriate wheelchairs and services which result in negative consequences in wheelchair users' health, quality of life, safety, and social participation. This study aimed to evaluate the influence of the Spanish Hybrid Course on Basic Wheelchair Service Provision, a training based on the World Health Organization's Wheelchair Service Training Program-Basic Level, to increase knowledge in basic level wheelchair service provision among a group of wheelchair service providers from Colombia. In addition, we developed a satisfaction survey which participants completed after the training to understand levels of satisfaction with the training intervention. METHODS: A quasi-experimental study was conducted to evaluate changes in basic level wheelchair knowledge using the Wheelchair Service Provision-Basic Test. Paired sample t tests were used to assess pre-and post-training changes in basic level wheelchair knowledge. The Hybrid Satisfaction Survey was developed in collaboration with a multidisciplinary, international stakeholders' group. The survey's construct of interest was level of satisfaction determined by interaction, instructor, instruction methodology, content, and technology, using a five-point Likert scale (0 = strongly disagree to 4 = strongly agree). The survey was completed anonymously after the training intervention and analyzed using frequencies and percentages. RESULTS: Fifteen wheelchair service providers in Colombia completed the Spanish Hybrid Course. Mean post-scores were significantly higher (Mean (M) = 56.13, Standard Deviation (SD) = 7.8), than pre-assessment scores (M = 50.07, SD = 8.38, t(14) = 4.923, p = <0.0001). Participants who completed the surveys (N = 15) reported that the Spanish Hybrid Course was well received, with 98.66% of responses distributed in favorable levels (>3). CONCLUSIONS: The Spanish Hybrid Course proved to be effective in increasing basic level wheelchair knowledge with a high satisfaction level among participants. Further testing is needed to evaluate the effectiveness of this course across different individuals and countries as a potential tool to build professional capacity in basic level wheelchair provision.