report from the world federation of occupational therapists’...

Report from the World Federation of Occupational Therapists’ (WFOT) Global Survey of Current Assistive Technology Use

World Federation of Occupational Therapists

Sarah Wallcook, Sophie Gaber, Liliana Alvarez, Samantha Shann,

Aline Cavalcanti Barroso, Ritchard Ledgerd

World Federation of Occupational Therapists | www.wfot.org | 8 June, 2018

@sarah_wallcook #WFOT18

World Federation of Occupational Therapists | www.wfot.org | 8 June, 2018 | #WFOT18 | @sarah_wallcook 2

Photos with kind permission: Siphael Urio & Mary Shanguya

Background

Today a billion people worldwide are estimated to need an assistive technology (AT) product.

Only 1 in 10 people have access to the AT they need.(World Health Organisation 2017)


Definition:

Assistive technology comprises products (both mainstream and customised), environmental modifications, services, and processes that enable the participation of people with disabilities in desired occupations, across multiple environments and without prejudice (Cook & Polgar 2015)

Objectives

• To identify the status of AT access across WFOT member countries;

• and determine perceived barriers and facilitators to AT universal access locally and globally.


Response receivedfrom member and non-memberindividuals and/or WFOT organisations.

How global?

https://www.freepik.com/free-vector/world-map-blue-template_718596.htm

No responses received. Mostly non-WFOT, someWFOT member countries.


51 out of 85 WFOT member organisations responded.

High representation from high income countries (World Bank 2018).

Responses to the Survey for Member Organisations:

4% Low income

12% Lower middle income

21% Upper middle income

63% High income

Income of countriesrepresented by responding member organisations


56% of member organisations overall reported that AT provision meets needs in their country well, or very well.

Significant difference when compared by World Bank income classification (2018).

Higher income associated with better met needs.

AT provision meeting needs.

0% 10% 20% 30% 40% 50% 60% 70%

Low income (n=2)

Lower middle income (n=6)

Upper middle income (n=11)

High income (n=33)

Very well Well Not well Poorly Don't know


Specific legislation and/or regulation regarding AT provision

63%Yes

37%No

0% 20% 40% 60% 80% 100%

Low income (n=2)

Lower middle income (n=6)

Upper middle income (n=11)

High income (n=33)

No Yes

Significant difference between presence of

legislation/ regulation compared by income

classification. Higher income associated with the

existence of legislation/regulation of AT provision.


Examples shown according to how well current need for AT in that country is being

met:

Very well Well Not well Poorly

Using local materials Training Training Position statement

Position statement Values Networking - GATE Training

Promotion Legislation Collation (providers) Working group

Competency profiles / Training

Recognition(insurance)

Promotion Practice guidelines

Training Weekly clinic Audit

Online services Online services

63% of member organisations shared future plans for AT provision


Practice Implications

1. WFOT will support member organisations to target standards of AT provision across lower and higher income countries.

2. Identify the variability of legislation and training requirements and how this impacts quality of AT provision.

3. For advocacy efforts, research is needed to identify whether occupational therapists are indeed the principle profession facilitating access to AT.

4. WFOT recognize international variability and empower member organisationsto develop locally specific strategies to increase access to AT.


The AT products that respondents work withShow

er

/ bath

/ to

ilet

chairs

Wheelc

hairs–

manual

/act

ive

use

Wheelc

hairs–

manual/

post

ura

lsu

pport

Hand r

ails

/ gra

bbars

Wheelc

hairs–

manual

ass

ista

nt

contr

olle

d

Wheelc

hairs–

pow

ere

d

Pre

ssure

relie

f cu

shoin

s

Ram

ps

-port

able

Walk

ing f

ram

es

–w

alk

ers

Pre

ssure

relie

f m

att

ress

es

Com

munic

ation

board

s/books/

card

s

Com

munic

ation

soft

ware

Rolla

tors

Oth

osi

s–

upper

limb

Canes

/ st

icks

Keyboard

/ m

ouse

em

ula

tion

soft

ware

Tim

em

aangem

ent

pro

duct

s

Pers

onal

em

erg

ency

ala

rm

Sta

dnin

gfr

am

es

adju

stable

Pill

org

anis

ers

Ala

rm –

light/

Sound/v

ibra

tion

Sim

plif

ied

mobile

phones

Cru

tches

auxill

ary

/elb

ow

Fall

dete

ctors

Inco

ntinence

pro

dcu

ts

Ort

hosi

s–

low

er

limb

Collectively respondents reported working with all 50 top priority

products listed in GATE (WHO 2107) @sarah_wallcook

Top responses shown. Proportion response <15% excluded

Most commonly used products - moreassociated with physical functioning


The AT products that respondents work withShow

er

/ bath

/ to

ilet

chairs

Wheelc

hairs–

manual

/act

ive

use

Wheelc

hairs–

manual/

post

ura

lsu

pport

Hand r

ails

/ gra

bbars

Wheelc

hairs–

manual

ass

ista

nt

contr

olle

d

Wheelc

hairs–

pow

ere

d

Pre

ssure

relie

f cu

shoin

s

Ram

ps

-port

able

Walk

ing f

ram

es

–w

alk

ers

Pre

ssure

relie

f m

att

ress

es

Com

munic

ation

board

s/books/

card

s

Com

munic

ation

soft

ware

Rolla

tors

Oth

osi

s–

upper

limb

Canes

/ st

icks

Keyboard

/ m

ouse

em

ula

tion

soft

ware

Tim

em

aangem

ent

pro

duct

s

Pers

onal

em

erg

ency

ala

rm

Sta

dnin

gfr

am

es

adju

stable

Pill

org

anis

ers

Ala

rm –

light/

Sound/v

ibra

tion

Sim

plif

ied

mobile

phones

Cru

tches

auxill

ary

/elb

ow

Fall

dete

ctors

Inco

ntinence

pro

dcu

ts

Ort

hosi

s–

low

er

limb

Collectively respondents reported working with all 50 top priority

products listed in GATE (WHO 2107) @sarah_wallcook

Top responses shown. Proportion response <15% excluded

Most commonly used products - moreassociated with physical functioning

OT

HE

R


Comparison of products by setting

Figure shows the overlap between top 4 products in community or inpatient mental health and community or inpatient physical health.

Mental health (n=43)

Physical health (n=191)

Shower / bath / toilet

chairs 51%, 77%

Hand rails / Grab bars 33%, 66%

Wheel-chairs manual active use 74%

Pressure relief cushions 64%

Pill organisers

40%

Time manage-

mentproducts

35%

In many instances products varied significantly by setting.

Products traditionally associated with physical or cognitive functioning were used across setting boundaries.


Steps to AT provision

Provide advice and/ or make

recommendations to…

…the person

…employer/provider

Provide instructions or training to…

…the person/family/carers

…other workforce inc. students

Assess suitability

Prescribe or order

Follow-up, maintain, adjust, monitor, repair.

Remove or replace

There were higher responses for the earlier stages of the provision process

Mid to later parts of the process received lower responses

Collectively, respondents were engaged in all 15 aspects of AT provision


Cost and supply routes of productsFree of charge to the person – government,

health or social coverage. 57%

Free of charge to the person – donated

6%Other: eg. part funded, part purchase.

9%

Borrowed by the person

5%

Purchased by the person

20%Rented by the person

3% Mostly custombuilt or modified

using locallyavailablematerials.

Mostly purchasedor received from a

supplier e.g. government,

charity, manufacturer, etc.

12%

88%

’Arm Pipe’ made by Icanho. Photos courtesyof Ian & Rosy Payne


Barriers to AT provisionFin

anci

alco

st–

to p

ers

on

Fin

anci

alco

st–

to s

erv

ice

Pro

duct

dem

and

outs

trip

ssu

pply

Lack

of

ava

ilable

mate

rials

Lack

of

train

ing

for

pra

ctitio

ners

Lack

of

oth

er

sect

or

serv

ices

Lack

of

clarity

re. re

sponsi

bili

ty

Lack

of

tim

eor

capca

tiy

Lack

of

follo

w-u

popport

unitie

s

Com

munity /

fa

mily

stig

ma

Tra

veldis

tance

sand g

eogra

phy

Ava

ilab./

suitable

transp

ort

Ava

ilable

needed

infr

ast

ruct

ure

Ava

ilab./

suitable

acc

ess

ib. st

ora

ge

None

of

these

apply

68% of respondents reported they had receivedsufficient training to facilitate AT and 29% had not.


Practice implications

Photos with kind permission: Ian & Rosy Payne

1. WFOT encourages organisations to scope and review community needs in relation to the match of AT products provided.

2. WFOT supports organisations to enact internationally recognised, contextually relevant, culturally sensitive best practice in AT provision.

3. WFOT recognizes the challenges and complexity of providing high quality, affordable AT and support organisations to deploy local strategies which increase access to AT.

WFOT have raised awareness of global AT provision with respect to occupational therapy and highlighted the opportunities that the profession has to build its global role in providing increased access to high quality, affordable AT.


Summary


Acknowledgements

The research presented in this report was carried out as part of the Marie Curie Innovative Training Network (ITN) action, H2020-MSCA-ITN-2015, under grant agreement number 676265.

Karolinska Institutet Travel Grant

With thanks to the WFOT member organisations and occupational therapists from around the world for taking part in the survey.

With thanks to friends around the UK and Tanzania who provided photographs.


References

Association for the Advancement of Assistive Technology in Europe. Service Delivery Systems for Assistive Technology in Europe: Position Paper. 2016 [cited 12 January 2018]. Available from: http://aaate.net/wp-content/uploads/sites/12/2016/02/ATServiceDelivery_PositionPaper.pdf

Australian Assistive Technology Conference AATC. Statement of Good Practice in Assistive Technology Provision in Australia. 2016 [cited 12 January 2018]. Available from: http://www.arata.org.au/public/33/files/General%20information/AATC%202016%20Statement%20on%20AT%20Good%20Practice.pdf

Borg J, Larsson S, Östergren PO. The right to assistive technology: for whom, for what, and by whom? Disability & Society. 2011; 26(2):151-167. DOI: 10.1080/09687599.2011.543862

Cook A, Polgar J. Assistive Technologies: Principals and Practice. 4th ed. Missouri: Elsevier Mosby; 2015.

The International Organization for Standardization ISO. ISO 9999:2016 Assistive products for persons with disability -- Classification and terminology [Internet]. ISO. 2016 [cited 1 November 2017] Available from: https://www.iso.org/obp/ui/#iso:std:iso:9999:ed-6:v1:en

United Nations. Convention on the Rights of Persons with Disabilities: an Optional Protocol [Internet]. United Nations. 2017 [cited 3 November 2017]. Available from: http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf

World Bank Country and Lending Groups [Internet] World Bank 2018 [cited 10 May 2018] Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups

World Federation of Occupational Therapists, Mackenzie L, Coppola S, Alvarez L, Cibule L, Maltsev S, Loh S et al. International Occupational Therapy Research Priorities. OTJR: Occupation, Participation and Health. 2017; 37(2):72-81. DOI: 10.1177/1539449216687528

World Health Organisation. Global Cooperation on Assistive Technology (GATE) [Internet]. World Health Organization. 2017 [cited 31 October 2017]. Available from: http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/

World Health Organisation. World Report on Ageing and Health [Internet]. World Health Organisation. 2015 [cited 3 November 2017]. Available from: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf

http://www.arata.org.au/public/33/files/General information/AATC 2016 Statement on AT Good Practice.pdf

http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/

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