Available Assistive Technology Outcome Measures: Systematic Review.

BACKGROUND: The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments. OBJECTIVE: This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice. METHODS: We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023. RESULTS: We analyzed 955 articles, of which 50 (5.2%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles. CONCLUSIONS: Among the 53 cited instruments, only 17 (32%) scales were designed to evaluate specifically assistive devices. Moreover, 64% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice.

From patient to maker - a workflow including people with cerebral palsy in co-creating assistive devices using 3D printing technologies.

Purpose: Digital fabrication, like 3D printing, is a new opportunity for rehabilitation professionals to produce customized assistive devices. It allows for empowerment and collaboration in device procurement, but practical implementations are scarcely described. We describe the workflow, discuss feasibility and propose directions for future work.Methods: We showcase a process of co-manufacturing a custom spoon handle together with two people with cerebral palsy. Our digital manufacturing process was centered around videoconferencing to remotely control the processes from design to final 3D printing. Device functionality and satisfaction were assessed using standard clinical questionnaires: the Individual Priority Problem Assessment Questionnaire (IPPA) and the Quebec User Satisfaction Assessment with Assistive Technology (QUEST 2.0).Results: IPPA was instrumental in assessing user needs and device effectiveness. QUEST revealed where to focus future design efforts.Conclusion: Involving people with disabilities in co-creation of assistive devices opens for new opportunities for healthcare providers that should be explored in depth using the described methodology. There may also be therapeutic benefits and we envisage specific actions to take in order to make it clinically viable.IMPLICATIONS FOR REHABILITATIONBest practices for co-creation of assistive devices, cost and benefits should be investigated and documented further.Standard questionnaires are useful for measuring effectiveness and satisfaction of co-created devices as well as for guiding design efforts.Co-creation may be a valuable element in therapeutic interventions as an opportunity to unfold creativity.

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.

The Technical Ability and Performing Scale (TAPS): A newly developed patient-reported functional rating scale for Musician's focal dystonia.

BACKGROUND: Musician's Focal Dystonia (MFD) is the most common adult-onset dystonia involving the hand and can cause a professional music career to end. MFD affects about 1% of professional musicians and is a challenging clinical condition to treat. This work aimed to validate the Technical Ability and Performing Scale (TAPS), a newly-developed patient-reported functional rating scale for the clinical assessment of the MFD burden. METHODS: Seventy-seven musicians with MFD (40.84 ± 13.14 years) who accessed "Sol Diesis Service" were consecutively enrolled. Each subject filled in the TAPS after playing six technical passages of different complexity for 45 s each. The clinicians also collected the Arm Dystonia Disability Scale (ADDS) and Tubiana-Chamagne Scale (TCS). Cronbach's α coefficient was used to assess reliability; concurrent validity was measured using correlation with validated tools (ADDS and TCS). RESULTS: Our results showed that the symptoms of dystonia appeared at around 33 years of age and lasted for at least three years. The Cronbach's α displayed good internal consistency (0.817) for Technical Ability (TA). The two TAPS scores, TA and Performing Score (PS), positively correlated with TCS total score and negatively with ADDS total score (concurrent validity). CONCLUSIONS: The TAPS is a reliable and valid tool for the clinical assessment of the MFD burden. This patient-reported outcome measure may facilitate patient engagement in decision-making about their care and can help healthcare professionals to monitor the musician's change during the rehabilitative intervention.

Modified Graded Motor Imagery for Musicians' Focal Dystonia: A Case Series.

PURPOSE: This study aimed to assess the effectiveness of the "modified graded motor imagery" (mGMI) protocol as a rehabilitative treatment of musician's focal dystonia (MFD). METHODS: Six musicians with MFD (age 43.83±17.24 yrs) performed the home-based mGMI protocol (laterality training, imagined hand movements and visual mirror feedback) once a day for 4 weeks. The mMGI protocol was designed to sequentially activate cortical motor networks and improve cortical organization. Subjects were evaluated before and after treatment with the dystonia evaluation scale (DES), arm dystonia disability scale (ADDS), Tubiana-Chamagne scale (TCS), and performing scale (PS). RESULTS: All participants were compliant with the mGMI treatment protocol without any adverse events. A significant improvement was measured in ADDS (p=0.047) and TCS scores (p=0.014) but not in DES (p=0.157). The severity of MFD decreased from moderate to mild in four patients. After mGMI treatment, all musicians were able to play easy pieces (TCS: median 3.5, IR 3.5-4). CONCLUSION: The findings from this pilot study suggest that home-based mGMI treatment is a feasible and promising rehabilitative approach for patients with mild to moderate MFD.

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.