Overview

The overall goal will be to identify and investigate barriers and opportunities to current coverage policy for CRT to fully understand their benefits and shortcomings for the development of a new proposed coverage policy. The aims of the project are to: 1) identify and investigate barriers to current coverage policy for Complex Rehabilitation Technology via a scoping review of current health & disability policy recommendations; 2) engage with a diverse group of stakeholders (who mostly are part of our overall project team) to assist with the creation of an online survey that validates common themes from the scoping review ; and 3) create and distribute an online Qualtrics survey to multiple healthcare stakeholder groups relevant to CRT.

The work is led and collaborated by the University of Pittsburgh, The Ohio State University, and the University of Michigan all high-ranking academic institutions along with premier access to health science library systems and key stakeholders at Assistive Technology Centers.  Engagement of stakeholders is critical throughout this project from consumers/caregivers, clinicians, suppliers, industry groups, manufacturers, payers, and professional associations.  Each will assist in identifying the current barriers that exist with current health policy and the ingredients to a new accountable coverage policy as well as.

Findings of this project will be summarized and disseminated in documents suitable for press releases, policy briefs, white papers, and peer-review publication, and will serve as stakeholder-driven guidelines for future development of new policies for CRT. In addition, the survey data will help establish stakeholder group consensus to provide elements and attributes of a new CRT policy.

Update

As of June 1, 2022

Sub-project #1: Scoping Review

Team members have completed all the steps in the scoping review process. The six steps are listed below and are based on the process described by Colquhoun et al. (2014).

1. Identifying the research question – COMPLETED
2. Identifying relevant studies – COMPLETED
3. Study selection – COMPLETED
4. Charting the data – COMPLETED
5. Collating, summarizing, and reporting the results – COMPLETED
6. Consultation – COMPLETED

The research question for the scoping review is “What is the complex rehabilitation technology (CRT) service delivery process for individuals with a disability that have a mobility impairment?”.

Based on the research questions we searched nine databases and four conference proceedings. The search resulted in 2,942 articles for review of title and abstracts. After completing the title and abstract review, we completed a full-text review for the remaining 314 articles. Finally, we identified 57 articles that were reviewed for data charting, collating, summarizing, and reporting. Based on the initial charting and collating process, we have identified 4 theme topics and 16 subtopics.

The four themes were wheeled mobility devices, policy, service delivery, and consumers.

Lastly, team members investigated Open Science Framework (OSF) (https://osf.io/) to assist with dissemination as it is a free, open-source web application that connects and supports research workflow, enabling scientists to increase the efficiency and effectiveness of their research. OSF allows researchers to collaborate, document, archive, share, and register research projects, materials, and data. The Scoping Discovery Review of CRT can be found at the following link, https://osf.io/rnqzx.

Dissemination Activities

Scoping Discovery Review of CRT has been listed in OSF’s Registries – https://osf.io/rnqzx

Betz, M., Galbreath, P., DiGiovine, C.P., & Schein, R.M. (2021, July). Complex Rehabilitation Technology Service Delivery: Scoping Review Process & Methodology. Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).https://www.resna.org/sites/default/files/conference/2021/ServiceDeliveryandOutcomes/68_Betz.html

• 2021 RESNA Student Scientific Paper Competition Runner-Up

DiGiovine, C.P., Schein, R.M., & Bet, M. (2022, February). Scoping Review Investigation of Complex Rehabilitation Technology and Next Steps. International Seating Symposium (ISS). https://www.seatingsymposium.us/event-schedule/event/3

Betz, M., DiGiovine, C.P., Galbreath, P., Stojkov, A., Berner, T., Hibbs, R., & Schein, R.M. (2022). Service delivery for complex rehabilitation technology: a scoping review. Disability and rehabilitation. Assistive technology, 1–19. Advance online publication. https://doi.org/10.1080/17483107.2022.2111609

Schmeler, M. R., & Dicianno, B. E. (2022). Viewpoints on the scoping review for the development of a novel coverage and service delivery policy for complex rehabilitation technology. Disability and rehabilitation. Assistive technology, 1–3. Advance online publication. https://doi.org/10.1080/17483107.2022.2113457

Sub-Project #2: Description of Stakeholder Viewpoints on CRT Policy – Survey Development

Based on the themes from the scoping review (sub-project 1) we developed the survey questions and conducted pre-testing of the survey. The survey questions were evaluated for clarity and

relevancy. We created four iterations of the survey and received feedback from three groups on the survey questions. We received feedback from a sub-set of the DRRP team, the entire DRRP team, and external stakeholders. In developing the survey, we balanced the comprehensiveness of the survey with the time it takes to complete the survey. The final survey contained 19 questions and address all the steps in the RESNA Wheelchair Service Delivery Guide. The questions either addressed the steps directly (e.g., device description) or indirectly (e.g., overall question about the service delivery process).

Dissemination Activities

Beauregard, T., Schein, R., Berner, T., & DiGiovine, C. (2022, April 22). Development of an online questionnaire examining stakeholder perception of the CRT service delivery process. The Ohio State University School of Health & Rehabilitation Sciences Research Day, Columbus, Ohio.

Beauregard, T., Schein, R., Berner, T., & DiGiovine, C. (2022, July). Development of an Online Survey to Examine Stakeholder Perception of the CRT Service Delivery Process. Paper Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). https://www.resna.org/sites/default/files/conference/2022/SeatingandMobility/StudentScientific/93_Beauregard.html

• 2022 RESNA Student Scientific Paper Award Winner

Sub-Project #3: Description of Stakeholder Viewpoints on CRT Policy – Survey Administration

Based on the survey development process, the final survey was distributed to over 30 stakeholder groups. The survey was launched on December 1, 2021, and closed shortly after the International Seating Symposium in March 2022. In total there were 1,282 recorded responses and team members have begun analyzing the data using both quantitative and qualitative analyses.

Dissemination Activities

• The plan is to present the results at the ISS, RESNA, and/or other appropriate conferences
• The team is analyzing the data to be submitted to appropriate Journals

Sub-Project #4: Common Reasons for Loss During Follow-up: Wheeled Mobility Service Delivery – Quality Assurance Reporting

Based on the date in the Functional Mobility Assessment – Universal Data Set (FMA-UDS) team members conducted a retrospective analysis to describe the type and frequency of “not active” responses. Specifically, we were examining the participation rate in the outcome measures portion of the wheelchair service delivery process, as this impacts the quality improvement program. An initial analysis of the participation rate indicates that there are several barriers and facilitators to participation in the outcome measures step of the service delivery process. These barriers and facilitators include acceptability, appropriateness, feasibility, and sustainability.

Dissemination Activities

Stojkov, A. & DiGiovine, C. (2022, April 22). Response Rate for Wheeled Mobility Service Delivery Quality Improvement Reporting. The Ohio State University School of Health & Rehabilitation Sciences Research Day, Columbus, Ohio.

Stojkov, A., Schein, R., Berner, T., & DiGiovine C. (2022, July). Response Rate for Wheeled Mobility Service Delivery Quality Improvement Reporting. Poster Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).

• Download Poster

Common Reasons for Non-participation in the Outcome Measurement Process: Wheeled Mobility Service Delivery – Quality Assurance Reporting

• In review at Disability and Rehabilitation: Assistive Technology

Sub-Project #5: Wheelchair Service Delivery Process Policy Review

One of the four themes that we identified during the scoping review process was the policies associated with the wheelchair service delivery process. The consultants, who reviewed the themes and sub-themes during phase 6 of the scoping review process, indicated that the policies that govern the wheelchair service delivery process had a significant impact on the quality of life of individuals who use complex rehabilitation technology. Therefore, team members decided to investigate the policies that address complex rehabilitation technology. Next literature was reviewed from the scoping review (sub-project 1) that fell in the policies theme. Team members then consulted with subject matter experts on the DRRP team to identify exemplar policies. Thirty peer-review articles, 8 Medicaid policies, 8 private insurance policies, and policies from the Department of Veterans Affairs were identified. Currently a manuscript is being drafted that compares the different policies.

Dissemination Activities

Betz, M., Beauregard, T., Stojkov, A., Schein, R., DiGiovine C. (2022, July). Complex Rehabilitation Technology Policy in the United States. Paper Presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). https://www.resna.org/sites/default/files/conference/2022/PublicPolicyandAdvocacy/103_Betz.html

Finalizing manuscript to submit to Journal of Disability Policy Studies policy forum

Other Project Dissemination Activities

DiGiovine, C.P. Schmeler, M.R., & Schein, R.M. (2021, July). ‘Overview of NIDILRR DRRP Program: Research on Healthcare Policy and Disability ‘The Right Wheelchair for the Right Person at the Right Time.’ Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).

In collaboration with the R2 project and with invited panelists an ISS Webinar Series: Network ISS. University of Pittsburgh, Network ISS: A Prelude to Pittsburgh (Producer). (2021). Complex Rehabilitation Technology Service Delivery and Clinical Assessment Research: What Happens Behind the Curtain. http://rstce.pitt.edu/RST CE_Webinar/2021/RSTCE_ISS WS2021.04.html

Smith, S., Cutler, K., Betz, M., Frick, B. (2021, November). ‘Research Symposium: Using Technology to Support Mobility ’. OCALICON.

Schmeler, M.R., DiGiovine, C.P., Hibbs, R., & Schein, R.M. (2022, July). Towards a Contemporary & Equitable Wheelchair Coverage Policy. Instructional Course presented at the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).