Use, Non-Use, and Satisfaction with Assistive Technology Provided by a Reutilization Program

1. Use, Non-Use, and Satisfaction with Assistive Technology Provided by a Reutilization Program Aimee Duplantis, OTS National AT Reuse Conference September 16, 2009

2. AT Reutilization Program for Independent Living Funded by: Rehabilitation Services Administration H235V060047

3. 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.

4. Presentation Overview • Describe the Assistive Technology (AT) Reutilization Program at Paraquad • Results of follow-up interviews with past participants

5. 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

6. 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

7. 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

8. 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

9. Demographics (N=40) *multiple choice question

10. Use Participation with reutilized AT Level of difficulty without AT Non-Use Contributing factors Method: Semi-Structured Interview • Initial questions to determine use or non-use • AT and Reutilization Program satisfaction

11. AT Acquired from Program

12. Use and Non-Use at Time of Interview

13. Price Comparison Reutilized AT Cost New AT Cost

14. 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

17. D4: Mobility d465 moving around using equipment Moving 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

18. What do you use your AT for? “[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 user D4: Mobility - moving with AT D6: Domestic life - acquisition of goods and services D9: Community, social and civic life - religion and spirituality

19. “[My transfer bench] actually helps me transfer over into the tubor 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

20. “[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

21. Without AT?Participation Restrictions “[My chair] doesn’t just help me. It makes it possible for me to do tasks.” Power wheelchair D4: Mobility, D6: Domestic life “Well it’s the only way I can bathe, so [the shower bench] is vital.” Transfer bench D5: Self-care

22. AT Use and Participation

23. Non-Use Participants Abandonment (n=6) Discontinued Use (n=2) Insurance paid for new manual wheelchair (n=1) Impairment change (n=1) • Mobility device breakdown (n=3) • Impairment change (n=2) • Provision of other AT from family (n=1)

24. AT Program Evaluation

25. 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

26. 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