Current government policy emphasises professional accountability, Best Value, evidence-based practice and outcomes for users and carers. In this context, being able to demonstrate the effectiveness of routine practice is increasingly important.
This article considers the key issues in collecting information about the outcomes of equipment and adaptations. These include: the assessment of the full range of outcomes; the timing of data collection; the use of standardised and individualised measures; and linking outcomes to interventions. Three approaches to evaluating the outcomes of equipment and adaptations are distinguished: functional status measures; health status or quality of life measures; and indirect approaches. Examples of each approach are provided and their strengths and limitations discussed.
Previous work on the outcomes of equipment and adaptations has neglected the perspectives of carers and the impact of service delivery (service process outcomes); further work on these areas is needed to ensure that all the outcomes of equipment and adaptations are fully evaluated.
Get full access to this article
View all access options for this article.
References
1.
AndrichRFerrarioMMoiM (1998) A model of cost-outcome analysis for assistive technology. Disability and Rehabilitation, 20(1), 1–24.
2.
BamfordCQureshiHNicholasEVernonA (1999) Outcomes of social care for disabled people and carers. Outcomes in Community Care Practice, No. 6. York: Social Policy Research Unit, University of York.
3.
BeardshawV (1988) Last on the list. Community services for people with physical disabilities. London: King's Fund Institute.
4.
BeattieA (1981) Aids to daily living for the patient with Parkinson's disease. British Journal of Occupational Therapy, 44, 53–55.
5.
BergnerMBobbitRACarterWBGilsonBS (1981) The Sickness Impact Profile: Development and final revision of a health status measure. Medical Care, 19, 787–805.
6.
BlaxterM (1976) The meaning of disability. A sociological study of impairment. London: Heinemann.
7.
BodiamC (1999) The use of the Canadian Occupational Performance Measure for the assessment of outcome on a neurorehabilitation unit. British Journal of Occupational Therapy, 62(3), 123–26.
8.
BowlingA (1995) Measuring disease: A review of disease-specific quality of life measurement scales. Buckingham: Open University Press.
9.
BowlingA (1997) Measuring health: A review of quality of life measurement scales. 2nd ed.Buckingham: Open University Press.
10.
BynumHSRogersJC (1987) The use and effectiveness of assistive devices possessed by patients seen in home care. Occupational Therapy Journal of Research, 3, 181–91.
11.
CaudreyDJSeegerBR (1983) Rehabilitation engineering service evaluation: A follow-up survey of device effectiveness and patient acceptance. Rehabilitation Literature, 44, 80–84.
12.
ChamberlainMAThornleyGWrightV (1978) Evaluation of aids and equipment for bath and toilet. Rheumatology and Rehabilitation, 17, 187–94.
13.
ChamberlainMAThornleyGStoweJWrightV (1981) Evaluation of aids and equipment for the bath: II. A possible solution to the problem. Rheumatology and Rehabilitation, 20, 38–43.
14.
ChessonRMacleodMMassieS (1996) Outcome measures used in therapy departments in Scotland. Physiotherapy, 82(12), 673–79.
CookS (1995) The merits of individualised outcome measures within routine clinical practice. Outcomes Briefing, Issue 6, 15–18. Leeds: UK Clearing House on Health Outcomes, Nuffield Institute for Health.
17.
de Clive-LoweS (1996) Outcome measurement, cost-effectiveness and clinical audit: The importance of standardised assessment to occupational therapists in meeting these new demands. British Journal of Occupational Therapy, 59(8), 357–62.
18.
DemersLWeiss-LambourRSkaB (1996) Development of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Assistive Technology, 8, 3–13.
19.
DemersLWesselsRDWeiss-LambourRSkaBde WitteL (1999) An international content validation of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Occupational Therapy International, 6(3), 159–75.
20.
Department of Health (1998) Modernising social services. London: Stationery Office.
21.
Department of Health (1999) The Personal Social Services Performance Assessment Framework. London: Stationery Office.
22.
DeRuyterF (1998) Concepts and rationale for accountability in assistive technology. In: RESNA. RESNA resource guide for assistive technology outcomes: Measurement tools (Volume I). Arlington, VA: RESNA.
23.
EakinPBairdH (1995) The Community Dependency Index: A standardised assessment of need and measure of outcome for community occupational therapy. British Journal of Occupational Therapy, 58(1), 17–22.
24.
EuroQol Group (1990) EuroQol – a new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208.
25.
FearingVGLawMClarkJ (1997) An occupational performance process model: Fostering client and therapist alliances. Canadian Journal of Occupational Therapy, 64(1), 7–15.
26.
FotoM (1996) Outcome studies: The what, why, how, and when. American Journal of Occupational Therapy, 50(2), 87–88.
27.
FrickeJ (1993) Measuring outcomes in rehabilitation: A review. British Journal of Occupational Therapy, 56(6), 217–21.
28.
FriesJFSpitzPWKrainesRGHolmanHR (1980) Measurement of patient outcome in arthritis. Arthritis and Rheumatism, 23, 137–45.
29.
GarberSLGregorioTL (1990) Upper extremity assistive devices: Assessment of use by spinal cord-injured patients with quadriplegia. American Journal of Occupational Therapy, 44(2), 126–31.
30.
GitlinLNSchemmRLLandsbergLBurghD (1996) Factors predicting assistive device use in the home by older people following rehabilitation. Journal of Aging and Health, 8(4), 554–75.
31.
GoldthorpeSBLloydN (1993) The awareness of and need for occupational therapy equipment and adaptations for elderly people. British Journal of Occupational Therapy, 56(7), 243–45.
32.
HammellKRW (1994) Establishing objectives in occupational therapy practice, part 2. British Journal of Occupational Therapy, 57(2), 45–48.
33.
HammondA (1996) Functional and health assessments used in rheumatology occupational therapy: A review and United Kingdom survey. British Journal of Occupational Therapy, 59(6), 254–59.
34.
HardingTBeresfordP (1996) The standards we expect. What service users and carers want from social services workers. London: National Institute for Social Work.
35.
HealyHRigbyP (1999) Promoting independence for teens and young adults with physical disabilities. Canadian Journal of Occupational Therapy, 66(5), 240–49.
36.
HeatonJBamfordC (2000) Assessing the outcomes of equipment and adaptations: Volume I: A literature review. Working paper number 1726. York: Social Policy Research Unit, University of York.
37.
HeywoodFSmartG (1996) Funding adaptations: The need to cooperate. Bristol: Policy Press.
38.
JeffreyLIH (1993) Aspects of selecting outcome measures to demonstrate the effectiveness of comprehensive rehabilitation. British Journal of Occupational Therapy, 56(11), 394–400.
39.
JenkinsonC, ed (1994) Measuring health and medical outcomes. London: UCL Press.
40.
JohnsonRG (1998) Measuring the impact of adaptations to the home for people with a physical disability: A pilot study using the Canadian Occupational Performance Measure. Salford: Department of Rehabilitation, University of Salford.
41.
LawMBaptisteSMcCollMOpzoomerAPolatajkoHPollockN (1990) The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57(2), 82–87.
42.
LawMPolatajkoHPollockNMcCollMACarswellABaptisteS (1994) Pilot testing of the Canadian Occupational Performance Measure: Clinical and measurement issues. Canadian Journal of Occupational Therapy, 61(4), 191–97.
43.
LawtonMP (1972) The dimensions of morale. In: KentDKastenbaumRSherwoodS, eds. Research, planning and action for the elderly. New York: Behavioural Publications.
44.
LawtonMP (1975) The Philadelphia Geriatric Morale Scale: A revision. Journal of Gerontology, 30, 85–89.
45.
LiddleJMarchLCarfraeBFinneganTDruceJSchwarzJBrooksP (1996) Can occupational therapy intervention play a part in maintaining independence and quality of life in older people? A randomised controlled trial. Australian and New Zealand Journal of Public Health, 20(6), 574–78.
46.
LoganPAAhernJGladmanJRFLincolnNB (1997) A randomised controlled trial of enhanced social service occupational therapy for stroke patients. Clinical Rehabilitation, 11, 107–13.
47.
MahoneyFIBarthelDW (1965) Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.
48.
MannWCHurrenDTomitaMCharvatB (1996) Use of assistive devices for bathing by elderly who are not institutionalised. Occupational Therapy Journal of Research, 16(4), 261–86.
49.
McAvoyE (1991) The use of ADL indices by occupational therapists. British Journal of Occupational Therapy, 54(10), 383–85.
50.
McCollMAPatersonMDaviesDDoubtLLawM (2000) Validity and community utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 67(1), 22–30.
51.
McCullochD (1991) Can we measure ‘output’? Quality-adjusted life years, health indices and occupational therapy. British Journal of Occupational Therapy, 54(6), 219–21.
MullenEJMagnaboscoJL, eds (1997) Outcomes measurement in the human services: Cross-cutting issues and methods. Washington: NASW Press.
54.
Neville-JanAPiersolCVKielhofnerGDavisK (1993) Adaptive equipment: A study of utilisation after hospital discharge. Occupational Therapy in Health Care, 8(4), 3–18.
55.
NoconAQureshiH (1996) Outcomes of community care for users and carers: A social services perspective. Buckingham: Open University Press.
56.
NolanMGrantG (1992) Regular respite: An evaluation of a hospital rota bed scheme for elderly people. London: Ace Books.
57.
NolanMKeadyJGrantG (1995) CAMI: A basis for assessment and support with family carers. British Journal of Nursing, 4(14), 822–26.
58.
NordenskiöldU (1994) Evaluation of assistive devices after a course in joint protection. International Journal of Technology Assessment In Health Care, 10(2), 293–304.
59.
NordenskiöldUGrimbyGHedbergMWrightBLinacreJM (1996) The structure of an instrument for assessing the effects of assistive devices and altered working methods in women with rheumatoid arthritis. Arthritis Care and Research, 9(5), 358–67.
60.
NordenskiöldUGrimbyGDahlin-IvanoffS (1998) Questionnaire to evaluate the effects of assistive devices and altered working methods in women with rheumatoid arthritis. Clinical Rheumatology, 17, 6–16.
61.
NorrisA (1999) Occupational therapy. A pilot study of an outcome measure in palliative care. International Journal of Palliative Nursing, 5(1), 40–45.
62.
NouriFLincolnN (1987) An extended activities of daily living scale for stroke patients. Clinical Rehabilitation, 1, 301–305.
63.
OortwijnWvan BeekumT (1997) Cost-effective rehabilitation technology through appropriate indicators: Experiences from validation. CERTAIN deliverable 4.2. Leiden, The Netherlands: TNO Prevention and Health, Technology in Health Care.
64.
PackerTLXiaopingY (1997) Needs of people with disabilities used to determine clinical education. International Journal of Rehabilitation Research, 20(3), 303–13.
65.
ParkerMGThorslundM (1991) The use of technical aids among community-based elderly. American Journal of Occupational Therapy, 45(8), 712–18.
66.
PerssonJHellbomGObergBvan BeekumTOortwijnWBrodinHLorentsenØAndrichRFerrarioMde WitteLWesselsR (2000) Final Report. DE3101 EATS: Efficiency of Assistive Technology and Services. Available at: http://www.siva.it.eng.products.download.htm Accessed on 8 July 2001.
67.
PincusTSummeyJASoraciSAWallstonKHummonNP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis and Rheumatism, 26(11), 1346–53.
68.
PollockN (1993) Client-centred assessment. American Journal of Occupational Therapy, 47(4), 298–301.
69.
PollockNBaptisteSLawMMcCollMAOpzoomerAPolatajkoH (1990) Occupational performance measures: A review based on the guidelines for the client-centred practice of occupational therapy. Canadian Journal of Occupational Therapy, 57(2), 77–81.
70.
PughMStansfieldS (1989) Drinking equipment: Preparing a DEAP report. British Journal of Occupational Therapy, 52(11), 416–20.
71.
QureshiH (1999) Outcomes of social care for adults: Attitudes towards collecting outcome information in practice. Health and Social Care in the Community, 7(4), 257–65.
72.
QureshiHPatmoreCNicholasEBamfordC (1998) Overview: Outcomes of social care for older people and carers. Outcomes in Community Care Practice, No. 5. York: Social Policy Research Unit, University of York.
73.
ReidDRigbyPRyanS (1999) Functional impact of a rigid pelvic stabiliser on children with cerebral palsy who use wheelchairs: Users‘ and caregivers’ perceptions. Pediatric Rehabilitation, 3(3), 101–18.
74.
RESNA (1998) RESNA resource guide for assistive technology outcomes: Assessment instruments, tools, and checklists from the field (Volume II). Arlington, VA: RESNA.
75.
RogersJCHolmMB (1992) Assistive technology device use in patients with rheumatic disease: A literature review. American Journal of Occupational Therapy, 46(2), 120–27.
76.
RogersJCHolmMB (1994) Accepting the challenge of outcome research: Examining the effectiveness of occupational therapy practice. American Journal of Occupational Therapy, 48(10), 871–76.
77.
SchemmRLGitlinLN (1998) How occupational therapists teach older patients to use bathing and dressing devices in rehabilitation. American Journal of Occupational Therapy, 52(4), 276–82.
78.
SchererMJ (1998) Characteristics of a meaningful outcome assessment. In: RESNA. RESNA resource guide for assistive technology outcomes: Measurement tools (Volume I). Arlington, VA: RESNA.
79.
SmithROSchererMJ (1998) Where are we headed with assistive technology outcomes? In: RESNA. RESNA resource guide for assistive technology outcomes: Measurement tools (Volume I). Arlington, VA: RESNA.
80.
SpencerJCDavidsonHA (1998) The Community Adaptive Planning Assessment: A clinical tool for documenting future planning with clients. American Journal of Occupational Therapy, 52(1), 19–30.
81.
StinemanMGEscarceJJGoinJEHamiltonBBGrangerCVWilliamsSV (1994) A case mix classification system for medical rehabilitation. Medical Care, 32, 366–79.
82.
StoweJChamberlainMA (1980) Aids for arthritics. Report of a survey on aids supplied postally by the British Rheumatism Association. British Journal of Occupational Therapy, 43(3), 80–84.
83.
ToomeyMNicholsonDCarswellA (1995) The clinical utility of the Canadian Occupational Performance Measure. Canadian Journal of Occupational Therapy, 62(5), 242–49.
84.
TromblyCARadomskiMVDavisES (1998) Achievement of self-identified goals by adults with traumatic brain injury: Phase I. American Journal of Occupational Therapy, 52(10), 810–18.
85.
TryssenaarJJonesEJLeeD (1999) Occupational performance needs of a shelter population. Canadian Journal of Occupational Therapy, 66(4), 188–96.
86.
TugwellPBombardierCBuchananWWGoldsmithCHGraceEHannaB (1987) The MACTAR Patient Preference Disability Questionnaire. Journal of Rheumatology, 14(3), 446–51.
87.
TysonRStrongJ (1990) Adaptive equipment: Its effectiveness for people with chronic lower back pain. Occupational Therapy Journal of Research, 10(2), 111–21.
88.
WashingtonKSchwartzIS (1996) Maternal perceptions of the effects of physical and occupational therapy services on caregiving competency. Physical and Occupational Therapy in Pediatrics, 16(3), 33–54.
89.
WolfH (1997) Assessments of activities of daily living and instrumental activities of daily living: Their use by community-based health service occupational therapists working in physical therapy. British Journal of Occupational Therapy, 60(8), 359–64.
90.
Wood-DauphineeSLOpzoomerAWilliamsJIMarchandBSpitzerWO (1988) Assessment of global function: The Reintegration to Normal Living Index. Archives of Physical Medicine and Rehabilitation, 69, 583–90.
91.
WressleESamuelssonKHenrikssonC (1999) Responsiveness of the Swedish version of the Canadian Occupational Performance Measure. Scandinavian Journal of Occupational Therapy, 6(2), 84–89.
92.
YerxaEJBurnett-BeaulieuSStockingSAzenSP (1988) Development of the Satisfaction with Performance Scaled Questionnaire (SPSQ). American Journal of Occupational Therapy, 42(4), 215–21.
