Project Leader(s): Rachel Hibbs, DPT, NCS, ATP & Gianna Rodriguez, MD

Co-Leaders:  Julie Mannlein, PT, ATP, Theresa F. Berner, MOT, OTR/L, ATP, & Juli Harrison OTD, OTR/L, ATP

Other Project Personnel: Lauren Terhorst, PhD, Carmen P. DiGiovine, PhD, ATP/SMS, RET, Richard M. Schein, PhD, MPH, & Hanju Zhu, MPH

Overview

One of the largest problems the field of CRT faces is funding and reimbursement for the technology. Documentation is not uniform from clinic to clinic, and it can be difficult to numerically measure the client’s need for different devices. The Centers for Medicare & Medicaid (CMS) coverage policies for CRT devices are also based more on diagnostic criteria and use within the home rather than the functional or participation needs of the person. The overall objective of this project is to systematically develop a unified and validated method for clinicians to assess and quantify a person’s need for different types and levels of CRT based on function, participation, and environmental factors rather than diagnosis. The tool will be called the Seating & Mobility Index (SMI) whereby items will be developed and operationally defined based on the International Classification of Function, Disability, and Health (ICF) constructs of body structures and function, activities and capacity, participation and performance (individual and societal), contextual factors (personal and environmental), and the importance of how these components affect and influence factors internal and external to an individual’s health status.

The clinical development and testing will be done so collaboratively through the University of Pittsburgh, The Ohio State University, and the University of Michigan all high-ranking academic institutions with Assistive Technology Centers. The project will be guided by an Advisory Group and other DRRP Team Members. This includes people with disabilities who will provide input on the development of the SMI. They will provide input into the components of the tool related to meaningfulness and burden during a CRT assessment. Clinician groups outside the project will also be engaged to assist with content validation.

The anticipated outcome of this project will be a first of its kind Seating & Mobility Index that has undergone initial content validation and inter-rater reliability as an indicator for levels of CRT interventions. It will streamline and standardize many components of the CRT assessment process to reduce burdens and more effectively document and communicate need and justification for interventions for insurance review purposes. It will also be used to build a new CRT policy model.

Update

As of June 1, 2023

Sub-Project #1: Review of Literature – COMPLETED

A review of current systematic reviews of assessment tools for measures of physical function or status, environment, participation, and activity that are related to a person’s need to use CRT was undertaken. Five hundred twelve systematic reviews were screened for inclusion, of which 223 were included for full text review to identify tools that could potentially be included as part of the SMI. From this search, 317 assessment tools were identified to be further evaluated. The team is currently reviewing these tools for clinical utility and validity to prepare a manageable list for use in survey of professionals in the field. In preparation of survey of professionals in the field, a template of the survey questions has been drafted for use when the initial list of 317 articles has been reviewed and whereby the team has eliminated tools for inclusion 41. A clinically relevant table of these tools is being developed with information gathered from review process for distribution to clinician reference.

Dissemination Activities

A clinically relevant table listing outcome tools associated with wheeled mobility and seating assessments filtered by ICF Categories, hyperlinks to more information of the tool and what it measures can be downloaded below.

• Download Document

Sub-Project #2: Clinician Viewpoints on Implementation of Outcomes Survey – DISSEMINATION

• An online survey was prepared for clinical professionals in the field and approved by the IRB based on results from sub-project #1
• Collected 34 responses from clinical subject matter experts (SMEs) in the field
• Twenty-five of the 43 listed objective measures were familiar to the SMEs
• Responses varied for each of the three statements of frequency, usefulness to justify CRT, and burdensome
• Most frequently used tools: MMT, TUG, Braden Scale, FMA, MAS, WPT, and MFRT

Dissemination Activities

• Manuscript in Preparation: ‘A Cross Sectional Descriptive Analysis of Clinician Opinions on Objective Measurement Tools and Utility for a Wheeled Mobility Device’

Sub-Project #3: Development of Clinical Documentation – In-Progress

• One team member from each of the academic medical centers (i.e University of Pittsburgh, The Ohio State University, and University of Michigan) collaborating in creating a checklist verifying each other’s documentation template of incorporating objective measures for each component of the assessment.
• Encompassing best practice guidelines described in the RESNA seating and positioning guide with additional objective measures included from sub-project #1 & input from #2.
• Working with IT to determine best method to share for integration into various types of electronic medical record software.

Dissemination Activities

A copy of each of the documentation templates from the seating and mobility clinics will be disseminated and posted on the website

Sub-Project #4: Development of Seating Mobility Index (SMI) – In-Progress

• Input from stakeholders has been sought at various levels
• Meeting monthly with statistical methodologist and weekly R2 team members to utilize best approach for content validity.
• Initial SMI ‘toolbox’ to have about 45-60 items; 20 clinical experts surveyed about most useful items of these tools. Removed items scoring lowest and decreased to a manageable 15 items.
• Identified a scoring strategy based on stratification of each item’s traditional scoring. Gathering information about cutoff scores and useful standardized metrics for each item in toolbox.
• Solicited feedback on beta version of SMI in March to current DRRP Clinical and Consumer stakeholders for any remaining edits.
• Drafted a template for how case studies can be written across the 3 academic medical centers for next phase.
• In discussions with IRB and planning to submit for exempt review status

Dissemination Activities

Hibbs, R., Harrison, J., Rodriguez, G., & Mannlein, J., (2023, April 13). Development of the Seating Mobility Index. International Seating Symposium (ISS).

Additional conference papers to present findings, webcasts (collaboration with Clinician Task Force and/or internal Continuing Education program), Magazine/News Outlets (HME News/Mobility Management) and appropriate journal articles will be created.

Other Project Dissemination Activities

Semancik, B., Schmeler, M.R., Schein, R.M., & Hibbs, R. (2021). Face Validity of Standardized Assessments for Wheeled Mobility & Seating Evaluations. Published online ahead of print, 2021 Sep 30. Assistive Technology. https://doi.org/10.1080/1 0400435.2021.1974980

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

Hibbs, R., Rodriguez, G., Mannlein, J., & Wright, M. (2022, February). Development of the Seating Mobility Index. International Seating Symposium (ISS). Virtual Conference.

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).

Schmeler, M.R., DiGiovine, C.P., Hibbs, R. & Schein, R.M. (2023, July). Steps Taken into the Assessment and Investigation of an Equitable Wheelchair Coverage Policy. Instructional Course Accepted to present at RESNA.