A Rehabilitative Approach to Assistive Device Interventions

BACKGROUND: In Denmark, the municipality grants assistive devices for free to people with disability, given that the device is expected to substantially improve the person’s ability to carry out one or more everyday activities. For efficiency purposes, municipalities usually grant simple devices such as crutches, shower chairs, and rollators with a minimum of assessment. This may, however, mean that the applicant’s needs for broader interventions such as seeing a doctor, having physical training, or needing to carry out different everyday activities may not be met.

Therefore, a rehabilitative assistive technology service delivery process, Rehab ATS, was applied, consisting of a home visit where the Individually Prioritised Problems Analysis (IPPA) was used to identify individually prioritized everyday activity problems, and solutions were based on a broader rehabilitative perspective.

PURPOSE: To investigate whether Rehab ATS can improve or retain older people’s functioning in terms of everyday activities and body function.

METHOD: The study was a pre–post study. Older persons ≥60 yr old, living in the municipality of Fredericia, applied for and were considered eligible for one or more simple assistive devices, and able to participate in an interview, were consecutively enrolled.

At baseline, municipality occupational therapists or physiotherapists visited the study participants in their home, collected demographic and health data, applied the IPPA, the 8-ft up-and-go-test, and the chair stand test. On basis of these data, the therapists recommended interventions.

At follow-up after a mean of 142 days, the same kinds of data were collected. Data were analyzed using nonparametric tests to analyze differences between baseline and follow-up data, and regression analyses were used to analyze factors that affected ease in performance of prioritized everyday activities and physical functioning.

RESULTS: At baseline, 201 study participants were enrolled, but 16 were lost to follow-up, mainly due to death and to severe illness, leaving 185 study participants. The median age was 80 yr, 68% were women, and 68% lived alone. The mean score of prioritized activity problems at baseline was 17.3 and at follow-up 12.1 (range = 0–25, higher score, larger activity problems), representing a large effect size (1.6). When asked, 44% found that their everyday activity problems were completely solved and 42% that the problems were partly solved, and 14% did not have their everyday activity problems solved at all. The study participants’ physical functioning was retained or maintained with a little effect size (0.17–0.24). Regression analyses showed that physical training did not have an impact on ease of priorities, everyday activities, and body functioning, even though about half of the participants carried out physical training programs. In all, 98% of all participants received one or more assistive devices.

DISCUSSION: The main effects seem to be the result of assistive device interventions selected individually to solve the individual’s everyday activity problems, indicating that the Rehab ATS may be effective. Physical training did not seem to have an impact on body functions or on improvement of prioritized activities.

The question is, however, whether the recommended physical training rendered was the most efficient training approach. In addition, it is not known whether the devices as such may have a similar impact on prioritized activities without using the IPPA. A controlled study is required to investigate these questions.

IMPACT STATEMENT: The study results can support assistive technology practitioners in basing their assistive device interventions and broader interventions on individually based identifications of prioritized activity problems.