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OT 541: Outcome Measures in Assistive Technology

Department of Occupational Therapy
University at Buffalo
Fall 2004

Instructor:

James A. Lenker, MS, OTR/L, ATP
522 Kimball Tower
Phone: 829-3141, ext. 109
Email: lenker@buffalo.edu

Course Description

The field of assistive technology (AT) relies on outcome measures to document efficacy of its clinical programs and interventions. OT 541 will explore quality assurance in AT service delivery (including consumer satisfaction) and functional outcomes measures (including cost effectiveness and quality of life) of AT interventions. The course will explore general themes in healthcare outcomes research, as well as issues that are germane to specific areas of AT practice. Students will develop their own project that defines and measures outcomes in a specific area of AT service delivery or product development. Course instructors will cover general outcomes topics relevant to evaluation of AT services and interventions. Topics will be sequenced to support the semester project required of each student. Lectures will analyze and discuss readings relevant to various elements of the project. Each week will feature exercises that guide students toward full conceptualization of their projects by mid-semester. The latter half of the course will include guest lectures by experts covering specific AT service areas. The discussions will serve as input to individual student projects, as well as provide students with broad perspectives on AT outcomes measurement. Guest lecturers will serve as resource persons and, potentially, mentors for the students' project experiences.

Rationale

Like other disciplines falling within the spectrum of healthcare, the field of assistive technology (AT) relies on efficacy studies to document the effectiveness of its clinical programs and interventions. The AT field is relatively young, and it is in great need of further research across settings, populations, and interventions in order to remain viable. Likewise, it is important for graduate students at UB to learn about the extant body of outcomes research in AT, as well as develop their own skills at identifying measurable outcomes and implementing data collection and evaluation plans.

Prerequisites: Permission of Instructor. Completion of previous coursework or clinical experience in assistive technology is strongly encouraged.

Learning Objectives

Students will be able to:

Required Readings

All readings for this course will be posted to UB Learns, typically in PDF or MS Word format. Bibliographic citations for most of these readings are included in the attached Course Bibliography. All readings will be assigned the week before they are discussed in class. Students should be prepared such that they can thoughtfully contribute to in-class discussions related to assigned readings.

Grading

Semester grades will be earned according to the following criteria:

A 90-100 B 80-89 C 70-79
D 65-69 F < 65  

Summary of Graded Activities

1. Attendance and Participation - 10%

This component will contribute 10 points (i.e. 10%) toward your final grade. Students are expected to attend and actively participate in all class sessions. Each unexcused absence will result in loss of 3 points. Four or more unexcused absences will result in loss of all possible attendance and participation points, as well as compromise the student's ability to successfully complete the other course requirements.

2. Class Presentation - 25%

Each student will be responsible for presenting an AT outcomes tool at one class session. You will sign up for one of the tools that is scheduled during Weeks 9-14 of the semester. You will be responsible for distribution of readings for class members to review in preparation for the session, as well as the presentation and discussion for the week that you are 'in charge'.

3. Semester Project in chosen AT area - 65%

You will develop an 8-10 page proposal that summarizes a rationale, design, and methods for assessing a set of outcomes in a setting of your choice. Your written proposal will be worth 40 points, and will be due at the end of the semester. You will also complete a poster presentation that summarizes your proposed project. The poster will be due at the end of the semester and will be worth 25 points.

Summary of tasks that will help you shape and prepare your project:

  1. Define topic area.
  2. Identify clinical setting which will serve as the frame of reference for your project.
  3. For your clinical setting, identify related legislation and funding issues related to procurement of reimbursement for AT services and equipment.
  4. Identify measurement needs at your clinical setting. What are the quality indicators for their AT services? What functional outcomes are meaningful to clinicians at this site? Are there existing tools that capture this information?
  5. How are consumer needs and priorities factored into your clinical setting? Define the consumer needs information that you will capture with your pilot study.
  6. Complete a literature review that summarizes the systematic approaches of other researchers.
  7. Define the variables, methods, and instrumentation you will use for your project.
  8. Prepare a poster that summarizes your proposed project

Special Accommodation

Students having a disability which requires special accommodation must contact the instructor during the first week of class in order to arrange for assistance in obtaining instructional accommodation. UB's Office of Disability Services is available for additional assistance if necessary.

OT 541 Topic Outline - Fall 2004

Week

Topic

Related Readings

1

Course Introduction
Overview of AT Outcomes

 

2

AT Outcomes Overview:  Where We Have (Not) Been

DeRuyter, 1995; 1997
Smith, 1996
Fuhrer, 2001

3

The Role of Theory & Conceptual Models

Lenker & Paquet, 2003; 2004
Scott & Sechrest, 1989
Keith, 1997
Lipsey, 1993

4

Measuring the "Strength" of AT Interventions

Hoenig et al., 2002
DeJong et al., 2004
Keith, 1997
Dijkers, 2002

5

Examples of AT Outcome Studies

Phillips and Zhao, 1993
Riemer-Reiss & Wacker, 2000
Kohn and Mortola, 1994

6

Examples of AT Outcome Studies

 

Mann et al., 1999
Jutai et al., 2000
Higgins & Raskind, 2000; 1997

7

Measuring Outcomes: What Makes a Good Tool?
AT Research & Measurement of Dependent Variables

Andresen, 2000
Keith, 1995
Lenker et al., 2005
Rust & Smith, 2005

8

Psychosocial Impact, Subjective Well Being, Quality of Life (PIADS)

Day and Jutai, 1996
Fuhrer, 2001
Ryff, 1995
Pape, 2003

9

Satisfaction, Usage & Usability (QUEST, MPT)

Keith, 1998
Demers et al.
Scherer
Batavia & Hammer, 1990
Wessels et al., 2004

10

Environmental Factors
* Community Barriers & Participation (CHIEF)
* Caregiver Assistance & Burden (Montgomery)

Whiteneck et al.
Allen, 2001
Gitlin et al., 1999; 2001

11

Occupational Performance (COPM, OT FACT)

 

Law et al., 1990
Smith, 2002

12

 

Device-specific measures: Wheeled Mobility (ATOM or FEW)

Dharne et al, 2006
Mills et al., 2002

13

Cost Benefit

 

Harris & Sprigle, 2003
Hass et al., 1997
Andrich, 1998
Warren, 1993

14

Poster Presentations
Course Evaluation

 

Bibliography - OT 541

Week 2: AT Outcomes Overview: Where We Have (Not) Been

DeRuyter, F. (1995). Evaluating outcomes in assistive technology: Do we understand the commitment? Assistive Technology, 7, 3-16.

DeRuyter, F. (1997). The importance of outcomes measures for assistive technology service delivery systems. Technology and Disability, 6, 89-104.

Fuhrer, M. J. (2001). Assistive technology outcomes research: Challenges met and yet unmet. American Journal of Physical Medicine and Rehabilitation, 80,528-535.

Smith, R.O. (1996). Measuring the outcomes of assistive technology: Challenge and innovation. Assistive Technology, 8, 71-81.

Week 3: The Role of Theory & Conceptual Models

Keith, R. A. (1997). The role of treatment theory. In M. J. Fuhrer (Ed.), Assessing Medical Rehabilitation Practices: the Promise of Outcomes Research (pp. 257-274). Baltimore: Paul H. Brookes.

Lenker, J. A., & Paquet, V. L. (2003). A review of conceptual models for assistive technology outcomes research and practice. Assistive Technology, 15(1), 1-15.

Lipsey, M. W. (1993). Theory as method : Small theories of treatments. In L. B. Sechrest & A. G. Scott (Eds.), Understanding Causes and Generalizing About Them (Vol. 57, pp. 88). Jossey-Bass Publishers: San Francisco.

Scott, A. G., & Sechrest, L. B. (1989). Strength of theory and theory of strength. Evaluation and Program Planning, 12, 329-336.

Week 4: Measuring the "Strength" of AT Interventions

DeJong, G., Horn, S. D., J.A., G., Slavin, M. D., & Dijkers, M. P. (2004). Toward a taxonomy of rehabilitation interventions: Using an inductive approach to examine the "black box" of rehabilitation. Archives of Physical Medicine and Rehabilitation, 85(4), 678-686.

Hoenig, H., Sloane, R., Horner, R.D., Zolkewitz, B.S., Duncan, P.W., & Hamilton, B.B. (2000). A taxonomy for classification of stroke rehabilitation services. Archives of Physical Medicine & Rehabilitation, 81, 853-862.

Hoenig, H., Duncan, P. W., Horner, R. D., Reker, D. M., Samsa, G. P., Dudley, T. K., et al. (2002). Structure, process, and outcomes in stroke rehabilitation. Medical Care, 40(11), 1036-1047.

Whyte, J., & Hart, T. (2003). It's more than a black box; it's a Russian doll: Defining rehabilitation treatments. American Journal of Physical Medicine and Rehabilitation, 82(8), 639-652.

Keith, R.A. (1997). Treatment strength in rehabilitation. Archives of Physical Medicine and Rehabilitation, 78, 1298-1304.

Week 5: Examples of AT Outcome Studies

Kohn, J.G., LeBlanc, M., & Mortola, P. (1994). Measuring quality and performance of assistive technology: Results of a prospective monitoring program. Assistive Technology, 6,120-125.

Phillips, B. & Zhao, H. (1993). Predictors of assistive technology abandonment. Assistive Technology, 5, 36-45.

Riemer-Reiss, M.L., & Wacker, R.R. (2000). Factors associated with assistive technology discontinuance among individuals with disabilities. Journal of Rehabilitation, 66(3), 44-50.

Week 6: Examples of AT Outcome Studies

Higgins, E. L., & Raskind, M. H. (1997). The compensatory effectiveness of optical character recognition/speech synthesis on reading comprehension of post-secondary students with learning disabilities. Learning Disabilities, 8(2), 75-87.

Higgins, E. L., & Raskind, M. H. (2000). Speaking to read: The effects of continuous vs. discrete speech recognition systems on the reading and spelling of children with learning disabilities. Journal of Special Education Technology, 15(1), 19-30.

Jutai, J. W., Rigby, P., Ryan, S., & Stickel, S. (2000). Psychosocial impact of electronic aids to daily living. Assistive Technology, 12, 123-131.

Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M., & Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: A randomized controlled trial. Archives of Family Medicine, 8(3), 210-217

Week 7: AT Research & Measurement of Dependent Variables: What Makes a Good Tool?

Andresen, E. M. (2000). Criteria for assessing the tools of disability outcomes research. Archives of Physical Medicine and Rehabilitation, 81(2), S15-S20.

Keith, R. A. (1995). Conceptual basis of outcome measures. American Journal of Physical Medicine and Rehabilitation, 74, 73-80.

Lenker, J. A., Scherer, M. J., Fuhrer, M. J., Jutai, J. W., & DeRuyter, F. (2005). Psychometric and administrative properties of measures used in assistive technology device outcomes research. Assistive Technology, 17, 7-22.

Rust, K., & Smith, R. O. (2005). Assistive technology in the measurement of rehabilitation and health outcomes: A review and analysis of instruments. American Journal of Physical Medicine and Rehabilitation, 84(10), 780-793

Week 8: Psychosocial Impact, Subjective Well Being, Quality of Life (PIADS)

Day, H., Jutai, J., & Campbell, K.A. (2003). Development of a scale to measure the psychosocial impact of assistive devices: Lessons learned and the road ahead. Disability and Rehabilitation, 24(1/2/3), 31-37.

Fuhrer, M.J. (2000). Subjectifyng quality of life as a medical rehabilitation outcome. Disability and Rehabilitation, 22 (11), 481-489.

Pape, T.L.B., Kim, J., & Weiner, B. (2003). The shaping of individual meanings assigned to assistive technology: A review of personal factors. Disability and Rehabilitation, 24(1/2/3), 5-20.

Ryff, C. D. (1995). Psychological well-being in adult life. Current Directions in Psychological Science, 4(4), 99-104.

Scherer, M.J. (1996). Outcomes of assistive technology use on quality of life. Disability and Rehabilitation,18(9), 439-448.

Week 9: Satisfaction, Usage & Usability (QUEST, MPT)

Batavia, A., & Hammer, G. (1990). Toward the development of consumer-based criteria for the evaluation of assistive devices. Journal of Rehabilitation Research and Development, 27, 424-436

Demers, L., Monette, M., Lapierre, Y., Arnold, D.L., & Wolfson, C. (2003). Reliability, validity, and applicability of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) for adults with multiple sclerosis. Disability and Rehabilitation, 24(1/2/3), 21-30.

Keith, R. A. (1998). Patient satisfaction and rehabilitation services. Archives of Physical Medicine and Rehabilitation, 79, 1122-1128.

Scherer, M. J. (1998). Matching Person & Technology. Webster, NY: Institute for Matching Person & Technology.

Wessels, R. D., de Witte, L. P., & van de Heuvel, W. J. A. (2004). Measuring effectiveness of and satisfaction with assistive devices from a user perspective: An exploration of the literature. Technology and Disability, 16, 83-90.

Week 10: Environmental Factors: Community Barriers & Participation (CHIEF), Caregiver Assistance & Burden (Montgomery)

Allen, S. M., Foster, A., & Berg, K. (2001). Receiving help at home: The interplay of human and technological assistance. Journal of Gerontology: Social Sciences, 56B(6), S374-S382.

Gitlin, L. N., Corcoran, M. A., Winter, L., Boyce, A., & Marcus, S. (1999). Predicting participation and adherence to a home environmental intervention among family caregivers of persons with dementia. Family Relations, 48(4), 363-372.

Gitlin, L. N., Corcoran, M. A., Wintger, L., Boyce, A., & Hauck, W. A. (2001). A randomized controlled trial of a home environmental intervention: Effect on caregiver efficacy and upset on daily function of persons with dementia. The Gerontologist, 41, 4-14.

Week 11: Occupational Performance (COPM, OT FACT)

Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., & Pollock, N. (1990). The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57(2), 82-87.

Smith, R. O. (2002). OT FACT: Multi-level performance-oriented software with an assistive technology outcomes assessment protocol. Technology and Disability, 14(3), 133-139.

Week 12: Device-specific measures: Wheeled Mobility (ATOM or FEW)

Dharne, M., Lenker, J.A., Harris, F., Sprigle, S. Content validity of the Assistive Technology Outcomes Measure (ATOM). Proceedings of the RESNA Annual Conference. Arlington, VA: RESNA.

Mills, T., Holm, M. B., Trefler, E., Schmeler, M. R., Fitzgerald, S., & Boninger, M. (2002). Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument. Disability and Rehabilitation, 24(1/2/3), 38-46.

Week 13: Cost Benefit

Andrich, R. (2002). The SCAI instrument: Measuring the costs of individual assistive technology programmes. Technology and Disability, 14, 95-99.

Andrich, R., Ferrario, M., & Moi, M. (1998). A model of cost-outcome analysis for assistive technology. Disability and Rehabilitation, 20(1), 1-24.

Harris, F., & Sprigle, S. (2003). Cost analyses in assistive technology research. Assistive Technology, 15, 16-27.

Hass, U., Andersson, A., Brodin, H., & Persson, J. (1997). Assessment of computer-aided assistive technology: Analysis of outcomes and costs. Augmentative and Alternative Communication, 13(2), 125-135.

Warren, C.G. (1993). Cost effectiveness and efficiency in assistive technology service delivery. Assistive Technology, 5,61-73.