Adaptive equipment can assist clients who have a disability or who have been unwell to be independent and safe in the performance of essential activities of daily living, such as bathing and toileting. Despite the important role which adaptive equipment can play in facilitating a successful return to home from hospital for clients after an illness, the rates of equipment abandonment reported over a 30 year period highlight the need for therapists to understand the complexities associated with the acceptance of equipment by clients. Recent literature has underscored the need to measure the outcomes of adaptive equipment use in order to understand the interaction between the client, the equipment, the activity and the context in which the activity is to be undertaken. It has been suggested that therapists need to better understand the human perspective of equipment use in order to minimise abandonment.
The purpose of this study was to identify the factors which influenced the post-hospital discharge use of rails, and bathing, toileting and dressing equipment, which had been prescribed by an occupational therapist. The specific aims included firstly to identify the current post-discharge utilisation rate for rails, and bathing, toileting and dressing equipment. Secondly, in order to understand why noncompliance occurred it was important to gain an insight into the perspectives of the clients and of occupational therapists, which were compared and contrasted with the literature in this practice area. The third aim was to identify the variables related to the use of rails, and bathing, toileting and dressing equipment. The final aim was to synthesise all of this information into a set of best practice guidelines that could be used by occupational therapists when prescribing adaptive equipment.
To achieve these aims, the study comprised three phases which used a combination of qualitative and quantitative research methods. Phase 1 utilised a qualitative approach in which focus group interviews were undertaken with 17 occupational therapists from two metropolitan hospitals. These interviews were conducted to identify the factors which therapists perceived to influence equipment use. Phase 2, involving 127 clients, was essentially a clinical audit at a major hospital, to determine the current utilisation rate for rails, and bathing, toileting and dressing equipment. Factors identified from the literature and from the occupational therapy 'experts' in the previous phase were also examined and triangulated with information obtained from clients who had been recommended adaptive equipment. In the final phase, logistic regression analysis was performed to explore the predictive relationship of factors identified in the previous phases, in relation to equipment use in a sample of 167 clients at two major hospitals.
The findings from phase 1 identified several factors which therapists perceived as influencing the post-discharge use of adaptive equipment. The majority of these factors were supported in the literature. The factors fell into three discrete categories: client-related, equipment-related and intervention-related. Client-related issues included diagnosis, functional and cognitive status, demographics, psychological factors, cultural differences, perceived need, client preferences, acceptance of illness and the client's previous use of adaptive equipment. Equipment availability, its appearance, the timing of its delivery and costs were identified in the equipment-related category. Client-collaboration, equipment training and follow-up were factors raised in the intervention-related category.
Results showed that in phase 2, the overall utilisation rate, at a mean of 7.4 weeks post-discharge from hospital was 64.4%. Prescribed rails were reportedly the most frequently used items (at 80.6%), with dressing equipment less frequently used (at 43.5%). Only requiring equipment on a short-term basis was the predominant reason for client abandonment of prescribed equipment. Additionally client involvement during the selection of the equipment, client perceptions of the benefit of the equipment, whether they received training in its use and whether their significant others were present during this training were all found to be associated with the post-discharge use of prescribed adaptive equipment. The triangulation process in this phase revealed many similarities among the factors associated with equipment use/non-use identified from each of the three different sources, namely the literature, the focus group with occupational therapy participants and the clients who had been prescribed adaptive equipment.
The findings of phase 3 confirmed those found in the second phase and lent further support to the recommendation for the use of a client-centred approach in the provision of prescribed adaptive equipment. Results highlighted the importance of considering clients' perceptions of their disability/illness, as well as features of the equipment before prescribing equipment. The clients' opinions regarding their expected use of the equipment and how useful they perceived it to be were also identified as needing consideration before finalising equipment recommendations. The presence of anxiety was found to adversely affect equipment use. Factors related to the occupational therapy intervention were identified as impacting on equipment use, including client involvement during equipment selection and the provision of equipment training that can be recalled.
In summary, the findings from this study point to the need for occupational therapists to ensure that adaptive equipment provision is client-centred. It is suggested that the Milieu Person Technology model (Scherer, 1998) could easily and effectively be incorporated into daily occupational therapy practice when prescribing adaptive equipment to client, as it parallels core values held by the occupational therapy profession. The key concepts of this model include collaboration with the client throughout the entire process, the comprehensive evaluation procedure (milieu, person and technology) and the use of various instruments to collect information about clients' perceptions. Such a model also allows for the identification of issues which might have a negative effect on compliance, as well as facilitating a process whereby both therapist and client can collaboratively develop strategies to counteract any abandonment which may occur.
An aim of this study was to synthesise the information from the literature and the results from phases 2 and 3, as well as therapists' and clients' perceptions regarding equipment use. This information forms the basis for a set of best practice guidelines for occupational therapists when prescribing adaptive equipment. These best practice guidelines include the following: client-focused intervention, comprehensive evaluation, training, follow-up and outcome measurement. These findings have important implications for the provision of adaptive equipment by occupational therapists. It is envisaged that the inclusion of these best practice guidelines in current practice will facilitate an approach whereby the incidences of equipment abandonment could be minimised.