Background
The term “assistive technology” refers to a wide variety of equipment, devices and aids that are meant to increase, preserve, or improve the functionality of people with disabilities in their day-to-day life. Rehabilitation and mobility devices are part of this technology, and they play a central role in improving the quality of life of individuals with disabilities or in supporting their participation in society. There are many models that focus on the two elements that are considered to have a particularly large impact on the quality of technological solutions offered to an individual with disabilities: the mechanism for providing the technology (which often consists of multiple stages and involves a variety of players) and the technology assessment process (which is determined by the individual’s personal characteristics, his environment, his support network, the characteristics of the technology available to him, etc.).
The State of Israel is seeking to make rehabilitation and mobility devices more accessible to individuals with disabilities by means of government funding from the National Unit for Rehabilitation and Mobility Devices in the Ministry of Health. The unit contacted the Disabilities Team at the Myers-JDC-Brookdale Institute in order to carry out a comprehensive study consisting of three components: an international review of the provision of rehabilitation devices in selected countries, a survey of individuals who have not exercised their eligibility to receive a device, and a survey of individuals who have exercised their eligibility and have recently received a device from the unit. This report focuses on the third component.
Objectives
The objective of the survey conducted among users of rehabilitation and mobility devices is to examine the following:
- Usage patterns (usage and non-usage) of the devices and the factors underlying those patterns.
- The impact of device usage on users (in terms of independence, quality of life, saving of resources, etc.).
- The process for approving eligibility and for the provision of rehabilitation and mobility devices.
Examination of these issues was expected to shed light on the changes and improvements that are needed in the service provision process. These are particularly relevant in advance of the expected implementation of the reform in the service provision process and the transfer of responsibility for the service to the health plans.
Methods
This component of the research is based on a telephone survey among individuals who received a rehabilitation and/or mobility device during the previous 6 to 18 months. The survey was conducted between May and June 2023, and 392 users responded (34% response rate), with between 38 and 41 users for each of the 10 device types included in the study.
Main Findings
The study found a high level of satisfaction with the referrer at the beginning of the process (generally a GP) (97% among children and 96% among adults) and the device recommender (generally a physiotherapist) (90% and 95%). The vast majority of users (90% and 95%) agreed that the recommendation they received met their needs. The stage of contacting the provider was also deemed appropriate. These contacts were generally made by a relative of the device user and usually occurred after contact was made with potential providers and according to information received on the services and the device. In the case of children, someone in the education system was involved in all stages of the provisioning process and follow up. With regard to the device itself, the vast majority of users reported that it was safe to use (94% and 91%) and suited their needs (82% and 83%), and that they use it every time or almost every time the need arises (94% and 92%). The majority of users use the device every day or almost every day, except in the case of stair climbers. The devices positively impact the users’ lives: 81% of children and 84% of adults stated that the device contributes to important areas of their lives and 86% and 87% respectively stated that it improves their quality of life. All users of powered wheelchairs (100%) and almost all group 1 wheelchair users (90%) also reported that using the device makes them feel more independent. Finally, linear regressions showed that the level of involvement of the recommender (whether or not he contacted the user, made an assessment by phone or through a physical visit with the user), the user’s previous experience with a similar device, the device’s fit to the user’s needs, user’s satisfaction with the provider, etc. all contribute significantly to the success of the service.
Recommendations
- The role of the recommender: It is important that the recommender initiate contact with every applicant for a device, and ideally his assessment should be made in a face-to-face meeting with the applicant. The visit should include functional assessment and examination of the residential environment, as well as consideration of personal characteristics such as the support available from the environment and the intended user’s previous experience with the device.
- Assistance in exercising eligibility: It is recommended that continuous communication be facilitated between the user and the recommender throughout the entire process, so that the applicant can stay updated on the progress of the application process and can contact the recommender if he encounters difficulties in exercising eligibility for the device. Additionally, it is advisable to identify individuals who may have more difficulty than others in exercising their eligibility due to the lack of a supportive environment (family members or professionals) or the fact that their primary language is not Hebrew.
- Usage guidance and support: It is recommended to provide comprehensive guidance on device usage and maintenance upon provision (including ways to contact the provider in case of malfunctions). Additionally, it is advisable to provide a clear address for further enquiries regarding device usage, such as the provider or the recommender. Furthermore, it is recommended that visual or written instructions for device usage be given upon provision, such as a guidebook in simple language, videos, illustrative pictures, etc.
- User’s involvement in the process: It would be worthwhile increasing user involvement and the user’s sense of partnership in the evaluation and provision of the device. This can be done by providing sufficient information about available devices when making the recommendation, engaging in a dialogue about the user’s principal needs and the way in which the different devices meet them, providing information about the subsequent stages of the process and what to expect, facilitating choice from among multiple providers, offering choices between various models of the device or various features in it, etc.
Citing suggestion: Yabo, M., & Gorbatt, A. (2024). Rehabilitation and Mobility Devices: The Use of the Device and its Effect on the User. RR-987-24. Myers-JDC-Brookdale Institute. (Hebrew)