Page 191 - Handbook of Electronic Assistive Technology

Chapter 6 • Environmental Control 179

Evidence Base for Effectiveness of EC Provision

The level of evidence for the effectiveness of EC provision is considered low, largely due
to the absence of high-quality studies of equivalence to randomised controlled trials or
those with multicentre format. The majority of studies are of small sample size or indi-
vidual case studies with insufficient diversity (Brandt et al., 2011). Hence well-designed
outcomes research is recommended to inform clinical decision making in the provision of
AT (Brandt et al., 2012).
However, among the individual studies, the reported study outcomes concluded that
EC provision did increase the independence of users, enabling some to live alone and
some to socialise more. Also, that quality of life and psychosocial function, when mea-
sured, were shown to be high among those with EC provision (Brandt et al., 2011).
Qualitative Indicators
Some studies have sought to evaluate the effectiveness of EC provision through qualita-
tive measures, such as themed analysis of structured interviews (Verdonck et al., 2011,
2014; Squires et al., 2013). While sample sizes are very small, findings suggest that EC
users perceive improvement in both anticipated and actual lived experiences with EC
equipment.
There is also noticeable evidence of effectiveness from the reporting undertaken by
NHS services in the United Kingdom, where reviews of existing EC users are undertaken.
This is in contrast to a service delivery model without routine clinical contact and review
(Novak, 1998) where abandonment was apparent.

Summary

In this chapter we have provided a brief history of ECS, and explained that the main rea-
sons for their provision are improved autonomy and quality of life, supporting indepen-
dence as well as enhancing well-being and psychological status of user and potentially
their carer. We have provided the reader with an outline of components of an ECS and how
the devices can be accessed.
Over the years the technology has evolved significantly with mainstream devices
increasingly offering EC functions. The advantage of this is that the technology is more
accessible and it increases choices for those who need this type of support. However,
the technology by itself does not provide independence for those with complex needs.
Support and maintenance play a significant role to successful implementation of EC,
in particular for those relying on these technologies for their activities of daily living.
In such situations a multidisciplinary assessment is essential to ensure that their needs
are met and appropriate support is in place. In the absence of employing a holistic
approach to implement ECS, there is a significant risk of abandonment of technology
which has its own consequences both financially and psychologically for the person
with complex needs.