A New Conceptual Model for Assistive Technology Outcomes Research and Practice

Predictive conceptual models help us frame research questions, interpret results, and guide clinical practice. Although numerous models have appeared in the assistive technology (AT) literature, none has been shown to predict AT usage. The lack of a valid predictive model indicates the need for development of new approaches to modeling AT outcomes. This article proposes a user-centered conceptual model that predicts AT usage as a function of the perceived relative advantages of AT. Device usage is not modeled as a one-time, all-or-nothing proposition, but as a decision process recurring over time. The influence of parallel interventions working concurrently with, or as an alternative to, AT is a central consideration that ultimately drives AT usage. Usage is shown as a proximal influence on AT impact, and AT impact is shown to be a predictor of future use. Research is cited supporting various elements of the new model.

[1]  David Wile Why Doers Do. , 1996 .

[2]  W. Dunn,et al.  The ecology of human performance: a framework for considering the effect of context. , 1994, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[3]  Ann Buysse,et al.  A social-cognitive model to predict the use of assistive devices for mobility and self-care in elderly people. , 2002, The Gerontologist.

[4]  M Dijkers,et al.  Measuring quality of life: methodological issues. , 1999, American journal of physical medicine & rehabilitation.

[5]  W. Gordon,et al.  Electronic assistive devices: their impact on the quality of life of high level quadriplegic persons. , 1981, Archives of physical medicine and rehabilitation.

[6]  I. Ajzen Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. , 2002 .

[7]  M. Conner,et al.  Social cognition models and health behaviour: A structured review , 2000 .

[8]  Doris Aaronson,et al.  Computer use by the visually impaired , 1987 .

[9]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[10]  R A Keith,et al.  Functional status and health status. , 1994, Archives of physical medicine and rehabilitation.

[11]  E Moodie,et al.  AAC systems: obstacles to effective use. , 1996, European journal of disorders of communication : the journal of the College of Speech and Language Therapists, London.

[12]  S. Garber,et al.  Upper extremity assistive devices: assessment of use by spinal cord-injured patients with quadriplegia. , 1990, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[13]  Kamesh Ramakrishna Review of "Systems Engineering Models of Human-Machine Interaction by William B. Rouse", North Holland. , 1981, SGAR.

[14]  L. Gitlin,et al.  Managing Dementia at Home: The Role of Home Environmental Modifications , 1996 .

[15]  L. Gitlin,et al.  Expanding caregiver ability to use environmental solutions for problems of bathing and incontinence in the elderly with dementia , 1993 .

[16]  R. Keith Treatment strength in rehabilitation. , 1997, Archives of physical medicine and rehabilitation.

[17]  Marti L. Riemer-Reiss,et al.  Factors Associated with Assistive Technology Discontinuance among Individuals with Disabilities , 2000 .

[18]  Stephen N. Calculator,et al.  AAC outcomes for children and youths with severe disabilities: when seeing is believing , 1999 .

[19]  M E Young,et al.  Assistive technology and the newly disabled adult: adaptation to wheelchair use. , 1993, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[20]  M. Scherer,et al.  Measuring the relationship of assistive technology use, functional status over time, and consumer-therapist perceptions of ATs. , 1996, Assistive technology : the official journal of RESNA.

[21]  Y. Robitaille,et al.  Factors Predicting the Implementation of Home Modifications Among Elderly People with Loss of Independence , 1994 .

[22]  L. Gitlin,et al.  Emerging concerns of older stroke patients about assistive device use. , 1998, The Gerontologist.

[23]  Stephen Kokoska,et al.  Family perspective on augmentative and alternative communication: Families of young children , 1995 .

[24]  R. L. Kirby,et al.  The Wheelchair Skills Test: a pilot study of a new outcome measure. , 2002, Archives of physical medicine and rehabilitation.

[25]  T M Gill,et al.  A critical appraisal of the quality of quality-of-life measurements. , 1994, JAMA.

[26]  Christine Marie Geiger,et al.  The Utilization of Assistive Devices by Patients Discharged from an Acute Rehabilitation Setting , 1990 .

[27]  James A Lenker,et al.  A Review of Conceptual Models for Assistive Technology Outcomes Research and Practice , 2003, Assistive technology : the official journal of RESNA.

[28]  M. Rodgers,et al.  Development of a functional assessment measure for manual wheelchair users. , 2003, Journal of rehabilitation research and development.

[29]  C. Wolfson,et al.  Reliability, validity, and applicability of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) for adults with multiple sclerosis , 2002, Disability and rehabilitation.

[30]  E. Agree,et al.  The influence of personal care and assistive devices on the measurement of disability. , 1999, Social science & medicine.

[31]  W W Hauck,et al.  A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. , 2001, The Gerontologist.

[32]  R. Cumming,et al.  Adherence to occupational therapist recommendations for home modifications for falls prevention. , 2001, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[33]  L. Gitlin,et al.  Factors Predicting Assistive Device Use in the Home by Older People Following Rehabilitation , 1996, Journal of aging and health.

[34]  M. Fuhrer Subjectifying quality of life as a medical rehabilitation outcome , 2000, Disability and rehabilitation.

[35]  Janice Light,et al.  Do Augmentative and Alternative Communication Interventions Really Make a Difference?: The Challenges of Efficacy Research , 1999 .

[36]  Hugh Stewart,et al.  Factors influencing the decision to abandon manual wheelchairs for three individuals with a spinal cord injury , 2002, Disability and rehabilitation.

[37]  R. Levine,et al.  How older adults perceive assistive devices in rehabilitation and home , 1993 .

[38]  Jenny Strong,et al.  Compliance with Prescribed Adaptive Equipment: A Literature Review , 2000 .

[39]  J. Jutai,et al.  Psychosocial Impact of Electronic Aids to Daily Living , 2000, Assistive technology : the official journal of RESNA.

[40]  J Angelo,et al.  Consumer participation in identifying research and development priorities for power wheelchair input devices and controllers. , 1995, Assistive technology : the official journal of RESNA.

[41]  C. Ryff Psychological Well-Being in Adult Life , 1995 .

[42]  M J Scherer,et al.  A framework for the conceptual modelling of assistive technology device outcomes , 2003, Disability and rehabilitation.

[43]  Gaylen Kapperman,et al.  Survey of the use of Assistive Technology by Illinois Students who are Visually Impaired , 2002 .

[44]  M. Holm Our Mandate for the New Millennium: Evidence-Based Practice , 2000 .

[45]  N. Edwards,et al.  Exploring seniors' views on the use of assistive devices in fall prevention. , 1998, Public health nursing.

[46]  R. Martin,et al.  Usage and effectiveness of rails, bathing and toileting AIDS. , 1996, Occupational therapy in health care.

[47]  Albert M. Cook,et al.  Assistive Technologies: Principles and Practice , 1995 .

[48]  M. Rodda,et al.  Factors Contributing to Parents' Selection of a Communication Mode to Use With Their Deaf Children , 2000, American annals of the deaf.

[49]  R A Keith,et al.  Patient satisfaction and rehabilitation services. , 1998, Archives of physical medicine and rehabilitation.

[50]  J. Rogers,et al.  The Use and Effectiveness of Assistive Devices Possessed by Patients Seen in Home Care , 1987 .

[51]  Dave L. Edyburn,et al.  Models, Theories, and Frameworks: Contributions to Understanding Special Education Technology , 2001 .

[52]  Susan L Garber,et al.  Wheelchair utilization and satisfaction following cerebral vascular accident. , 2002, Journal of rehabilitation research and development.

[53]  R. Keith Conceptual basis of outcome measures. , 1995 .

[54]  R. McAndrew,et al.  Measurement of patient-derived utility values for periodontal health using a multi-attribute scale. , 1996, Journal of clinical periodontology.

[55]  J Ramsdell,et al.  Compliance with social and safety recommendations in an outpatient comprehensive geriatric assessment program. , 1994, Journal of gerontology.

[56]  Elaine Trefler,et al.  No Aid, an Etran, a Minspeak: a comparison of efficiency and effectiveness during structured use , 1985 .

[57]  Jean Dansereau,et al.  Wheelchair Seating Aids: How Satisfied Are Consumers? , 1999 .

[58]  B Phillips,et al.  Predictors of assistive technology abandonment. , 1993, Assistive technology : the official journal of RESNA.

[59]  L H Kraskowsky,et al.  Factors affecting older adults' use of adaptive equipment: review of the literature. , 2001, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[60]  M. Dijkers,et al.  Measures of social outcomes in disability research. , 2000, Archives of physical medicine and rehabilitation.

[61]  L. Gitlin,et al.  Issuing assistive devices to older patients in rehabilitation: an exploratory study. , 1995, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[62]  L. Verbrugge,et al.  The great efficacy of personal and equipment assistance in reducing disability. , 1997, American journal of public health.

[63]  M J Fuhrer,et al.  Assistive Technology Outcomes Research: Challenges Met and Yet Unmet , 2001, American journal of physical medicine & rehabilitation.

[64]  Perception of the impact of assistive devices on daily life of three individuals with quadriplegia. , 1995, Assistive technology : the official journal of RESNA.