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Anttila H.,Finnish National Institute for Health and Welfare | Samuelsson K.,Linkoping University | Salminen A.-L.,Social Insurance Institution | Brandt S.,Danish Center for Assistive Technology
Technology and Disability

This overview summarizes the available evidence from systematic reviews of outcomes studies on various assistive technologies (AT) for persons with disabilities. Systematic reviews published between January 2000 and April 2010 were identified by comprehensive literature searches. Study selection, data extraction and methodological quality evaluation were done by two authors independently. The quality of evidence was summarized by explicit methods. Types of disabilities, settings, and AT interventions were recorded. Outcomes were mapped according to the Taxonomy of Assistive Technology Device Outcomes. Forty-four systematic reviews were included in this overview. High-quality evidence was found in single AT (positive effects of providing AT in connection with home assessment and hearing aids, no effects of hip protectors) for limited populations (older people at home, people with hearing loss, and older people in institutional care, respectively). Low-quality or unclear evidence was found for the effectiveness of the other evaluated AT interventions. Current gaps in AT outcomes research were identified. Many frequently used devices have not been systematically reviewed. Well-designed outcomes research to inform clinical decision-making is urgently needed. The systematic review methodology seems to be feasible for summarising AT outcomes research, but methodological development for grading and for primary studies is warranted. © 2012-IOS Press and the authors. All rights reserved. Source

Mindegaard P.,Danish Center for Assistive Technology
Assistive Technology Research Series

In October 2008 a principle ruling affirmed that Electronic-motor-driven wheelchairs with manual steering (EWM) must be regarded a consumer good, and not an assistive aid. The decision was very controversial, and was followed by much discussion in the media, as it can be seen as a showdown with normal Danish practice, where AT are provided free of charge. Regarding the decision, from now on the applying citizen has to pay half of the price for the EWM. To study the consequences of the decision, a case study was made in the municipality of Odense. The results from the study shows, that there are an almost constantly number of applying citizens. But in the period from 2007 to 2010 increasingly more citizens avoid to make use of the appropriation, especially due to economically reasons. Therefore it is predicted, that the decision, confirmed by The National Social Appeals Board, may threaten to give increased inequality in reason to health. © 2011 The authors and IOS Press. All rights reserved. Source

Lyhne T.,Danish Center for Assistive Technology
Assistive Technology Research Series

Objective. To present the Danish National Database on Assistive Technology (The Danish AT Database) and its impact in the context of the Assistive Technology service delivery system in Denmark. Main content Grants for assistive technology products are provided by the public authorities under the Social Services Act, the Health Act, the Education Act and others. Under the terms of the Social Services Act, the municipalities provide grants for assistive technology products and consumer goods for persons with long-term mental or physical disability, if the assistive technology product or consumer good can relieve the long-term effects of the disability to a great extent, facilitate day-to-day home life to a great extent, or is necessary to allow the person in question to carry out a job. Besides providing grants for assistive technology the municipality shall ensure the availability of free advice for persons with physical or mental disabilities, which implies advice on choosing assistive devices as well as directions for their use. In Denmark there is no complete list of the assistive technology or consumer goods that can be provided by grants, but information on most products being provided are found in the Danish AT Database. The Danish AT Database is designed to provide information on assistive technology products and associated information for end-users and their relatives, case-managers, health-care professionals, manufacturers, suppliers, policy makers and researchers. The database provides detailed information about a vast number of assistive technology products available from Danish suppliers, contact information on suppliers and manufacturers, news, literature references, links to other information systems in the field of assistive technology, a forum for user-to-user information and debate, and references to principal rulings in relation to appeals about the allocation of assistive devices or home adaptations in accordance with the Social Services Act. The product information in the database is updated online by Danish suppliers and validated by an editorial team at the Danish Centre for Assistive Technology. Results. The Danish AT Database currently includes information on about 20.000 product series, 900 suppliers, 300 literature references and 150 principal rulings. At www.hmi-basen.dk the Database has about 50.000-60.000 visits every month and besides data from the database is used in data management systems in nearly all municipalities, hospitals and institutions running an assistive technology warehouse. Conclusion. The Danish AT Database plays a key role in the provision process of assistive technology in Denmark primarily for professionals, end-users and their relatives, suppliers and manufactures. © 2011 The authors and IOS Press. All rights reserved. Source

Brandt A.,Danish Center for Assistive Technology | Samuelsson K.,Linkoping University | Toytari O.,Finnish National Institute for Health and Welfare | Salminen A.-L.,Social Insurance Institution of Finland
Disability and Rehabilitation: Assistive Technology

Objective. To examine activity and participation, quality of life, and user satisfaction outcomes of environmental control systems (ECSs) and smart home technology (SHT) interventions for persons with impairments. Method. A systematic review. Seventeen databases, three conference proceedings, and two journals were searched without language or study design restrictions covering the period January 1993 - June 2009. Reviewers selected studies, extracted data, and assessed the methodological quality independently. Result. Of 1739 studies identified, five effect studies and six descriptive studies were included. One study was on SHT and the remainder on ECS; functionalities were overlapping. The studies varied in most aspects, and no synthesis could be drawn. However, ECS/SHT tended to increase study participants' independence, instrumental activities of daily living, socialising, and quality of life. Two studies showed high user satisfaction. The level of evidence was regarded as low, mainly due to small study sizes, lacking confounder control, and a majority of descriptive studies. Conclusion. Due to few and small studies and study diversity, it was not possible to determine whether ECS/SHT have positive outcomes for persons with impairment, even though the technologies seem to be promising. High quality outcomes studies such as randomised controlled trials, when feasible, and large longitudinal multi-centre studies are required. © 2011 Informa UK, Ltd. Source

Samuelsson K.A.M.,Linkoping University | Toytari O.,Finnish National Institute for Health and Welfare | Salminen A.-L.,Social Insurance Institution | Brandt A.,Danish Center for Assistive Technology
Prosthetics and Orthotics International

Background: Effects presented on the use of assistive devices such as prosthesis are often based on laboratory findings (i.e. efficacy).Objectives: To summarise and evaluate findings from studies on effectiveness of lower limb prostheses for adults in real life contexts, primarily in terms of activity, participation, and quality of life (QoL) and secondarily in terms of user satisfaction, use/non-use, and/or cost-effectiveness.Study Design: Systematic review.Methods: We included controlled studies and non-controlled follow-up studies including both baseline and follow-up data. Using 14 different databases supplemented with manual searches, we searched for studies published from 1998 until June 2009.Results: Out of an initial 818 identified publications, eight met the inclusion criteria. Four studies reported on the effectiveness of a microprocessor-controlled knee (MP-knee) compared to a non-microprocessor- controlled knee (NMP-knee). Results were inconsistent except for quality of life and use/non-use, where the authors reported an improvement with the MP-knee compared to the NMP-knee. The remaining four studies included a diversity of prosthetic intervention measures and types of endpoints.Conclusions: Overall, there was an inconsistency in results and study quality. This review highlights the need for high-quality research studies that reflect the effectiveness of different prosthesis interventions in terms of users' daily living and QoL.Clinical relevanceClinical guidelines are important to every practitioner. Information on expected effectiveness from assistive devices should be well founded and contain both facts about the device quality and its contribution to users' daily lives. Thus, studies based on users' experiences from prosthetic use in everyday life activities are of great importance. © The International Society for Prosthetics and Orthotics 2012. Source

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