Assistive technology in the measurement of rehabilitation and health outcomes - A review and analysis of instruments

Rust KL, Smith RO: Assistive technology in the measurement of rehabilitation and health outcomes: A review and analysis of instruments. Am J Phys Med Rehabil 2005;84:780-793. This article examines the scoring of assistive technology (AT) in health and rehabilitation outcome scales and delineates implications. Searches of MEDLINE, CINAHL, and PsychINFO databases and relevant functional assessment text books provided the basis for this investigation of 100 widely used health and rehabilitation outcomes instruments. Each of the 100 instruments was assessed to the nature and degree in which AT was included in the instrument scales, content, and scoring procedures. We classified instruments into categories according to the methods used to consider AT in the scoring. We found that 30% of the instruments ignored AT. When instruments included AT, 44% of the instruments lowered the score, 22% of the instruments allowed AT use for the highest score, and 4% of the instruments provided a mix. Analysis also revealed whether the 100 instruments isolated the effect of AT as a contribution to outcome. The results indicate that rehabilitation and health outcomes instruments inconsistently consider AT as an intervention for people with disabilities. This inconsistency in scoring leads to muddled and potentially invalid assessments of rehabilitation outcomes. Due to the common concurrent use of AT in rehabilitation intervention, if AT use is not documented or controlled within outcomes study research designs or by the instrumentation, the outcomes of any targeted intervention may be confounded by the contribution of AT in the overall assessment of the person's function, participation, or quality of life.