Page 109 - Handbook of Electronic Assistive Technology

96 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

Therefore it is important that time is built into the service model to allow for review to
ensure appropriateness of the provision.

Outcome Measures for Assistive Technology

This section focuses on why outcome measures are needed, and gives some examples and
their limitations when considering AT.
Outcome measures are used for a number of reasons. As well as being an essential
component for defining the effectiveness of clinicians’ practice (Reiman, 1988), Cole and
Hudak (1994) suggested that standardised measures could provide consistent, compa-
rable and valid data. This is pertinent for the field of AT provision as it is a relatively new
area and there are insufficient data for activities such as benchmarking of AT devices, the
services and comparing different populations of patients.
Increasingly, healthcare organisations are being scrutinised by external agencies such
as the Care Quality Commission, which concern themselves not only with measures of
parameters such as waiting times but also with the quality of care (Lilford et al., 2007). It is
therefore important to use standardised outcome measures that capture the patient’s per-
spective (Lorig et al., 1996; Beaton et al., 2001). They can also provide measurement of the
service delivery and its cost effectiveness, and establish the effectiveness of AT over time
or steer the new development of AT (Gelderblom and de Witte, 2002).
In general in rehabilitation, outcome measures are used to measure actual or perceived
ability of an individual to carry out an activity, completing personal care and participating
in life situations (Jette et al., 2009). The benefits of AT in that setting were largely unchal-
lenged by policy makers, funders and service providers and mostly assumed to be self-
evident (Scherer, 2002; Fuhrer et al., 2003). What was of more interest was the reason for its
abandonment and the outcomes of AT service delivery (Murphy et al., 1996; Phillips et al.,
1993; Scherer, 1996, 2002) because the abandonment of AT could lead to loss of functional
abilities, increase in carers’ costs and culminate in ineffective use of funds by services
(Kerrigan, 1997). However, with increasing financial pressures on healthcare organisations
the cost of these devices and services needs to be evaluated and therefore interest in out-
come measures is growing.
While a number of published outcome measures exist for AT, not many are in routine
use. Jette et al. (2009) suggest that this could be due to barriers such as lack of familiarity,
inadequate training and access to tools. Some of the outcome measures developed to date
are discussed next.

International Classification and Function

International Classification and Function (ICF) is defined by the WHO (2001) in clinical
settings and it is used for functional status assessment, goal setting, treatment planning
and monitoring. The literature suggests that components of this can also be used as an
outcome measurement in rehabilitation (Jutai et al., 2005; Kohler et al., 2013).