Rate and Duration of Adaptive Equipment Use and Factors Affecting Use After Discharge From Inpatient Rehabilitation

PURPOSE: Patients discharged from inpatient rehabilitation are often sent home with adaptive equipment (AE) to promote their safety and independence. However, if AE is functionally necessary but is not being used, it can lead to reduced independence and safety, potentially resulting in injury and readmission. Therefore, understanding the factors that contribute to continued use or nonuse of AE after discharge can assist occupational therapy practitioners in their clinical reasoning when providing equipment. The research question for this study was, What is the rate and duration of AE use and reasons for or against use once patients are discharged from inpatient rehabilitation?

METHOD: This study was a literature review of studies examining postrehabilitation use of AE published in peer-reviewed journal articles in English after 1996. Thirteen databases were searched using refined search terms and inclusion and exclusion criteria. Of 3,146 articles found, 12 were selected for review to explore the rates and duration of continued AE use by patients of various ages and diagnoses. Articles were classified on the basis of the American Occupational Therapy Association’s levels of evidence and Tomlin and Borgetto’s (2011) research pyramid. Researchers read selected articles and synthesized the information collectively to look for themes. A critically appraised topic table was used to identify and organize the research objectives, populations served, interventions, outcome measures, and results of each study.

RESULTS: Four main themes emerged relating to continued use of AE: patient, environment, equipment, and training factors. About two-thirds of patients continued to use recommended AE postdischarge. Patient-based factors associated with higher rates of use included being over age 70, being female, having lower income, not having a caregiver, and having less education. Other significant factors were cognitive ability to learn and recall training, diagnosis, perception of equipment, perception of need, length of time since discharge, anxiety, and involvement in the equipment selection process. Primary environmental factors included generalization of equipment use. Equipment-based factors included the suitability of devices to fulfill the intended purpose, quality, aesthetics, and cost. The training factors affecting use and recall included time of delivery, frequency, duration, and instructional methods, all of which were patient specific depending on diagnosis and cognitive status.

CONCLUSION: Occupational therapy practitioners should approach AE prescription in a patient-centered manner, including the patient in the decision-making process. Understanding the patient’s perception of the equipment can have an impact on actual use. The selection of equipment should include consideration of patient fit (aesthetics, suitability, durability, cost). Awareness of the patient’s anxiety, cognitive status, and motivation is important because of their effects on the ability to learn. Training considerations include timing (ability to learn, stage of recovery) and the inclusion of family members or caregivers. Additionally, consideration of equipment suitability within the home is key to use. Patients can benefit from a follow-up home visit to reassess the continued fit of the equipment. This knowledge was translated via a presentation and decision-making tool to obtain patient data to optimize equipment prescription.

IMPACT STATEMENT: Understanding factors affecting continued use of AE after discharge from inpatient rehabilitation is important because of the implication that if functionally necessary equipment is not being used, patient safety and independence can be compromised.

References

Hoffmann, T., & McKenna, K. (2004). A survey of assistive equipment use by older people following hospital discharge. British Journal of Occupational Therapy, 67, 75–82. https://doi.org/10.1177/030802260406700204

Kraskowsky, L. H., & Finlayson, M. (2001). Factors affecting older adults’ use of adaptive equipment: Review of the literature. American Journal of Occupational Therapy, 55, 303–310. https://doi.org/10.5014/ajot.55.3.303

Tomlin, G., & Borgetto, B. (2011). Research pyramid: A new evidence-based practice model for occupational therapy. American Journal of Occupational Therapy, 65, 189–196. https://doi.org/10.5015/ajot.2011.0008284

Wielandt, T., McKenna, K., Tooth, L., & Strong, J. (2006). Factors that predict the post-discharge use of recommended assistive technology (AT). Disability and Rehabilitation: Assistive Technology, 1, 29–40. https://doi.org/10.1080/09638280500167159

Wielandt, T., & Strong, J. (2000). Compliance with prescribed adaptive equipment: A literature review. British Journal of Occupational Therapy, 63, 65–75. https://doi.org/10.1177/030802260006300204