FS2 Update Report - Treatment of AT in Current/Emerging Health & Rehabilitation Outcome Measures
(updated June 18, 2003)
This field scan identified and critically reviewed approximately 100 functional assessment instruments from the fields of medical rehabilitation, gerontology, occupational and physical therapy, special education, and speech/language therapy. Analysis classified the 100 instruments as to how assistive technology is treated in the scoring process. 30 instruments failed to acknowledge the use of assistive technology in their outcome scoring. These instruments totally ignore AT as a covariate. Forty-five instruments incorporate the use of AT in the score, but define a positive outcome without the use of AT. Thus, they lower the outcome score when AT is used. Twenty-one instruments allow AT to elevate the outcome score, but most of these did not differentiate among types of devices used, and it is not uncommon to find instruments that do not differentiate between person assist and device assist. A small subset of instruments specifically tease out the impact of AT.
Two trends were identified in this review. First of all, the inconsistent consideration of AT in the evaluation of functional performance has not improved over the past 35 years as evidenced by the methods of the Katz Index of ADL (1963) and the federally mandated OASIS (1998). In both instruments there are items in which AT is allowed to be used without reducing the overall functional score and there are items in which AT use lowers the score. Clearly, the role that assistive technology plays in increasing functional performance remains problematic in outcomes measurement. Fortunately, the second identified trend, increasing consensus regarding the patient’s point of view as central to monitoring healthcare outcomes, is a positive one.
While not included in the 100 instruments mentioned above, this field scan also reviewed developing assessment instruments as available. Feedback to developers as to their incorporation of AT was provided.
It is overwhelmingly clear that when health and rehabilitation assessments measure outcomes, they do not understand what and if any of the outcomes are due to assistive technology interventions. To adequately include patient preference and goal setting, a “next generation” instrument, tapping the advances in computer technology and measurement theory must be developed to meet the unique outcomes measurement needs that will measure the increased functionality afforded to individuals with disabilities when they use assistive devices.