A user-centred approach to assess the effectiveness of outdoor mobility devices and services

In the Netherlands, the provision of mobility devices and services in the area of daily living is the responsibility of municipalities. The provision is regulated by the Service for the Disabled Act (SDA) and concerns wheelchairs and outdoor transportation facilities. In general, the service delivery process can be described as follows. A person with mobility problems takes the initiative and applies for a service with the municipality or local authority. An independent needs assessor is contacted to assess the client’s need and to give advice on the care needed. The local authority decides whether or not to fund the recommended (or other) mobility device and/or service. In case of device provision, authorisation is given to a dealer who delivers the device to the applicant. After devices and services are provided there is no routine follow-up in order to see if the provision fits the client’s need. As with other medical interventions, a growing need exists to prove the effectiveness of the resources spent on assistive technology (AT) and service delivery. This is not only because the growth in demand has outstripped the increase in available budgets, but there is also a trend towards increasing levels of professionalisation (Wessels et al., 2000). For the client, however, the most significant reason for assessing effectiveness is that his or her expressed need is fulfilled at an optimum level. This expressed need might be different from the need formulated by the professional, which is more normative (Bradshaw, 1997). Therefore the most direct way to evaluate the problems clients encounter is to assess the degree to which goals are attained or problems are solved by means of the provision delivered. The IPPA (Individually Prioritised Problem Assessment) is an instrument that was developed to assess the extent to which the problems in daily activities identified by the client have been diminished as a result of this provision (Wessels et al., 2000). So far, no research has been performed to assess the effect of the provision of outdoor mobility devices and services provided through the SDA. Where effectiveness is concerned, the question is whether people’s mobility problems diminish after provision and whether participation is enhanced. This study attempts to assess the specific goals pursued by those who apply for a mobility services by means of IPPA.