Danish Center for Assistive Technology

Århus, Denmark

Danish Center for Assistive Technology

Århus, Denmark
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Anttila H.,Finnish National Institute for Health and Welfare | Samuelsson K.,Linköping University | Salminen A.-L.,Social Insurance Institution | Brandt S.,Danish Center for Assistive Technology
Technology and Disability | Year: 2012

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.

Samuelsson K.A.M.,Linköping 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 | Year: 2012

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.

Helle T.,University of Aalborg | Helle T.,Lund University | Nygren C.,University of Southern Denmark | Slaug B.,Lund University | And 5 more authors.
Scandinavian Journal of Occupational Therapy | Year: 2010

This study addresses development of a content-valid cross-Nordic version of the Housing Enabler and investigation of its inter-rater reliability when used in occupational therapy rating situations, involving occupational therapists, clients, and their home environments. The instrument was translated from the original Swedish version of the Housing Enabler, and adapted according to accessibility norms and guidelines for housing design in Sweden, Denmark, Finland, and Iceland. This iterative process involved occupational therapists, architects, building engineers, and professional translators, resulting in the Nordic Housing Enabler. For reliability testing, the sampling strategy and data collection procedures used were the same in all countries. Twenty voluntary occupational therapists, pair-wise but independently of each other, collected data from 106 cases by means of the Nordic Housing Enabler. Inter-rater reliability was calculated by means of percentage agreement and kappa statistics. Overall good percentage agreement for the personal and environmental components of the instrument was shown, indicating that the instrument was sufficiently reliable for application in practice and research in the Nordic context. The varying kappa results highlight the need for further study in order to understand the influence of prevalence more profoundly, which should be kept in mind when interpreting the results. © 2010 Informa Healthcare.

Brandt A.,Danish Center for Assistive Technology | Samuelsson K.,Linköping University | Toytari O.,Finnish National Institute for Health and Welfare | Salminen A.-L.,Social Insurance Institution of Finland
Disability and Rehabilitation: Assistive Technology | Year: 2011

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.

Brandt A.,Danish Center for Assistive Technology | Brandt A.,Lund University | Kreiner S.,Copenhagen University | Iwarsson S.,Lund University
Disability and Rehabilitation: Assistive Technology | Year: 2010

Purpose. The aim of this study was to investigate the constructs of mobility-related participation and user satisfaction, two important outcome dimensions within praxis and research on mobility device interventions. Method. To fulfill this aim, validity and reliability of a 12-item scale on mobility-related participation and a 10-item scale on user satisfaction were examined in the context of older people's powered wheelchair use (n=111). Rasch analysis and correlation analysis were applied. Results. Construct validity of both scales was confirmed. The reliability of the user satisfaction scale was good, while the mobility-related participation scale was not optimal in discriminating between persons with a high degree of mobility-related participation. It was demonstrated that mobility-related participation and user satisfaction are separate, not related constructs. Conclusions. It can be concluded that the investigated mobility-related participation and user satisfaction constructs appear to be valid. Since the two constructs are not related and both yield important information, both dimensions should be evaluated in outcomes research and praxis targeting powered wheelchair interventions. Reliability problems of the mobility-related participation scale indicate the complexity of this construct. The results have been instrumental in the development of a new scale for measuring mobility-related participation 'The NOMO 1.0'. © 2010 Informa UK Ltd.

Lyhne T.,Danish Center for Assistive Technology
Assistive Technology Research Series | Year: 2011

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.

Bjornskov S.,Danish Center for Assistive Technology | Brandt A.,Danish Center for Assistive Technology | Brandt A.,Lund University
Assistive Technology Research Series | Year: 2011

Caregivers are among those professionals who experience the highest incidence of low back pain and low back injuries, and one of the most frequently described reasons for this is person transfers. This paper reports on a controlled intervention study in two Danish municipalities with perceived strain during person transfer, self reported low back pain and low back injuries as main outcomes. The intervention was implemented in one municipality consisting of maximum use of assistive devices for person transfer combined with organizational changes. The other municipality served as control group. The study population consisted of all permanently employed caregivers in the two municipalities, and data was collected by means of a questionnaire at baseline and after 10 months of follow-up. At follow-up the caregivers in the intervention group reported lower perceived strain during person transfer and fewer low back injuries compared to the control group. However, no differences were found in terms of intensity and duration of low back pain. Reasons for the differences are discussed. © 2011 The authors and IOS Press. All rights reserved.

Mindegaard P.,Danish Center for Assistive Technology
Assistive Technology Research Series | Year: 2011

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.

Helle T.,Lund University | Brandt A.,Lund University | Brandt A.,Danish Center for Assistive Technology | Slaug B.,Lund University | Iwarsson S.,Lund University
International Journal of Public Health | Year: 2011

Objective: To increase the understanding of how definitions of standards for housing design influence the proportion of dwellings not meeting the standards and the proportion of individuals defined as having accessibility problems. Methods: The sample included old people and their dwellings in three European countries (N = 1,150). Frequencies and percentages were reported and empirical distribution functions were used. Results: Depending on the functional profile and standards in question, the magnitude of influence of the standards differs in extent, e.g., the existing standard for door openings at the entrance (defined ≥75 cm) implied that the proportion of dwellings not meeting it was 11.3% compared to 64.4%, if the standard was set to ≥83 cm. The proportion of individuals defined as having accessibility problems for profiles not using mobility devices was 4-5, 57% for profiles using them and 1-3% for the total sample if the standard was set to 90 cm. Conclusion: Research-based standard definitions for housing design are necessary to ensure that they actually lead to enhanced accessibility, which is a prerequisite for the independence and health of persons with functional limitations. © 2011 Springer-Verlag.

Lofqvist C.,Lund University | Pettersson C.,Lund University | Brandt A.,Danish Center for Assistive Technology
Disability and Rehabilitation: Assistive Technology | Year: 2012

Purpose: The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life. Method: The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use. Results: The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 5691% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased. Conclusions: This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. Implications for Rehabilitation Powered wheelchair and scoter interventions increased independence in mobility and easiness in mobility-related participation in everyday life. Easiness in participation can be considered an important follow-up dimension after powered wheelchair and scooter interventions. A 4-month follow-up time after powered wheelchair and scooter intervention seems adequate. © 2012 Informa UK, Ltd.

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