AOTJ Update

Considerations in assistive technology: research advancements

Dr Jacki Liddle and Dr Tammy Aplin Editorial Board Members, Australian Occupational Therapy Journal

Globally, there is increasing awareness of the benefits, barriers to access and impact of assistive technology (AT). Earlier this year, the World Health Organization (WHO) and UNICEF “Global report on assistive technology” was released, highlighting global unmet need and recommendations for change1. In Australia, advocacy groups and the media have highlighted issues of unmet need, with the new funding systems creating complexity and challenges to accessing required AT and supports2. There has also been attention on the importance of considering the risks and access of new and emerging technologies, such as Artificial Intelligence. In particular, there has been focus on the human rights implications of these new technologies, with emphasis on technology as an enabling right including accessible mainstream technologies3 .

Reflecting the need to explore the complex and diverse range of AT-related supports, recent publications in the Australian Occupational Therapy Journal (AOTJ) have highlighted a range of technologies and areas of recommendations and action consistent with the WHO global report. Publications in recent years have focused on lower-tech AT, assessment and support processes, economic impact, and broader sociotechnical and cultural considerations.

While perhaps not an obvious example of AT, assistance dogs have received heightened research and practice attention in recent years, with the NDIS supporting assistance dogs as reasonable and necessary support for some participants. While assistance dogs can support participation and promote psychological wellbeing, gaps in therapist knowledge and skills have been identified. A recent survey of occupational therapists reported in the AOTJ indicated expanding occupational therapists’ knowledge, and increasing access to reporting templates, supports and education-improved clinical reasoning and practice in this area4 .

While assistance dogs represent a relatively new technology for therapists, home modifications and the recommendation of AT and task modification during home visits is a common aspect of occupational therapy in supporting safe discharge from hospital and community participation. While a routine part of practice, high-level research such as randomised controlled trials are uncommon. The Lockwood (et al., 2020) study was an important step in evidencing this routine practice5. Their process evaluation within a randomised controlled trial of multidisciplinary rehabilitation after hip fracture explored the impact of home visits to inform and support AT recommendations including home modification. The impact of a home visit included more recommendations and higher adherence to the recommendations (including those for AT). The authors suggest home visits support collaborative decision-making, therefore supporting improved clinical outcomes.

Like home-visiting practice, the recommendation of wheelchairs is a common role for occupational therapists. Access to wheelchair assessment; however, can be inequitable. Telehealth therefore offers the potential of increased access when collaboratively designed. In New Zealand, the design of a telehealth wheelchair assessment service was explored from a range of stakeholders, including Indigenous (Maori) therapists and wheelchair users6. The work indicated the importance of considering risk, uncertainty, and access and equity within service delivery and design. Culturally safe communication practices were emphasised, as were user goal-focused approaches.

Given the strain on the health system, there is growing need to provide evidence for the value of AT and related occupational therapy services, in particular the economic impact. A recent publication in the AOTJ provides an excellent example of how research can provide high-level evidence of the value of AT. The study indicated the social return on investment of modified vehicles for people with disability7. Vehicle modifications can be an important AT in enabling access to the driving or passenger role. Costs can vary widely; however, this analysis indicated that even with higher-cost modifications, and in scenarios where costs were shared between the consumer and funders, there is a clear return on investment. The authors indicated that with the highest-cost scenarios, payback periods were less than four years. This approach helps providers determine, monitor and advocate for the impact of this type of intervention.

References can be viewed by scanning the QR code