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Daniel T, Spingler T, Hug A, Rupp R, Weidner N, Wensing M, Ullrich C. Provision and use of assistive products in patients after stroke and spinal cord injury in Germany: a qualitative interview study. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 38709221 DOI: 10.1080/17483107.2024.2348069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Mobility impairments are a common consequence of stroke and spinal cord injury (SCI). Assistive products (APs) such as wheelchairs are often needed for activities and participation. The aim of the study was to explore the provision and use of APs in Germany and to identify associated factors underlying this practice. MATERIALS AND METHODS Semi-structured interviews were conducted with 19 professionals from outpatient neurorehabilitation services (three general practitioners, five physical therapists, five occupational therapists, one speech therapist, one neuropsychologist, two outpatient nurses, one rehab technician and one social worker), two patient advocates (long-term survivors, each stroke and SCI) and 20 patients (10 each after stroke and SCI with mobility impairment, and first-ever affected). Analysis was performed by qualitative content analysis. RESULTS Reported experiences were mixed, varying from high satisfaction to unusable APs and unmet needs. Identified factors associated with these experiences were related to care pathways, care coordination, inter-professional collaboration, professionals' knowledge and patient information, cost coverage, and approval procedures. CONCLUSION Overall, patients seem satisfied with the APs they receive, but patients with more severe mobility impairments in particular experience deficits in the provision and use of APs. Further research is needed to develop and test strategies for the provision and use of APs.
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Affiliation(s)
- Tiziana Daniel
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Tamara Spingler
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Hug
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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Mishra S, Laplante-Lévesque A, Barbareschi G, Witte LD, Abdi S, Spann A, Khasnabis C, Allen M. Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review. Disabil Rehabil Assist Technol 2024; 19:474-485. [PMID: 35906719 DOI: 10.1080/17483107.2022.2099021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/03/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Globally, assistive technology (AT) is used by over 1 billion people, but the prevalence of needs and access to AT in specific countries or regions is largely unknown. This scoping review summarises the evidence available on the prevalence of needs, access and coverage of AT in the World Health Organisation European Region and the barriers and facilitators to its use. METHODS Relevant publications were identified using a combination of two strategies: 1) a systematic search for AT publications in five scientific literature databases; and 2) consultations with 76 of the Region's AT experts. RESULT The search strategies yielded 103 publications, 62 of them identified by the systematic search. The included publications were predominantly from six countries, and 18 countries were unrepresented. Information on AT use for specific functional impairments was present in 57 publications: AT for hearing impairment in 14 publications; vision in 12; mobility, 12; communication, 11; self-care, 6; and cognition, 2. AT needs for vision and hearing impairment were more likely to be met (1-87% and 5-90%, respectively) compared with communication and cognition impairments (10-60% and 58%, respectively). The barriers and facilitators to AT access described were linked to accessibility, affordability and acceptability. CONCLUSION Data on AT prevalence and coverage are limited in both quantity and quality. Agreed-upon definitions of functional impairment and assistive product categories and standards for data collection are needed to facilitate data comparisons and to build a more representative picture of AT needs and coverage.Implications for rehabilitationComprehensive and disaggregated data concerning the prevalence of needs and coverage of AT is needed to enable the development of responsive policies and actions.The literature available on the prevalence of needs and coverage of AT in the WHO European Region is primarily focussed on a small subset of countries and comparisons between studies are limited due to the use of different data collection strategies.Evidence concerning barriers and facilitators to AT access across countries is more consistent and can be organised across the key themes of accessibility, affordability and acceptability of AT.There is a need for consensus among multiple AT actors on standardised definitions for functional impairment and assistive product categories and standards for data collection to enable a more representative picture to be built of AT needs and coverage across the WHO European Region and globally.
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Affiliation(s)
- Satish Mishra
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Luc De Witte
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, United Kingdom
| | - Sarah Abdi
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, United Kingdom
| | - Alice Spann
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, United Kingdom
| | | | - Michael Allen
- United States Agency for International Development, Washington, DC, United States of America
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Perotti L, Klebbe R, Maier A, Eicher C. Evaluation of the quality and the provision process of wheelchairs in Germany. Results from an online survey. Disabil Rehabil Assist Technol 2023; 18:205-214. [PMID: 33164613 DOI: 10.1080/17483107.2020.1841837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restrictions in mobility can lead to social and health-related issues. Assistive technologies and devices can help to sustain or regain mobility in affected persons. One of the most commonly used devices is the wheelchair. Many wheelchair users experience difficulties within the provision process and with the device itself. The presented study investigated the satisfaction with the wheelchair and the corresponding provision process. METHODOLOGY A comprehensive online survey was conducted. The questionnaire surveyed the quality of wheelchairs and the corresponding provision process among wheelchair users in Germany. Descriptive methods were used to analyse the results. Sub-groups were classified according to age, sex, waiting time for wheelchair, financing and type of wheelchair. RESULTS After cleaning the data, 110 datasets remained for analysis. The predominant reasons for wheelchair acquisition were independence and the replacement for a defective wheelchair. Wheelchair quality aspects as well as the corresponding provision process were rated medium. Issues were found regarding waiting times, repair services and communication between service providers. DISCUSSION The presented results reflect issues in the quality of wheelchairs and their provision process. Inequality between different sub groups is evident. Although some results should be considered with caution due to unequal group sizes, clear trends can be seen which confirm results from other studies throughout the literature. CONCLUSION The presented cross-sectional study results give an important overview about the user satisfaction with the quality and provision process of wheelchairs. A longitudinal study accompanying users during the provision process is being recommended as a more in-depth study.IMPLICATIONS FOR REHABILITATIONLow durability and adaptability were identified as main issues regarding wheelchair quality.Waiting times for wheelchairs were perceived as too long by the users and make up the main factor for low satisfaction with the wheelchair provision process.Reduced waiting times for wheelchairs (especially for electric wheelchairs) can improve overall satisfaction with the assistive device.Waiting times could be reduced by a more efficient application and provision process.
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Affiliation(s)
- Luis Perotti
- Clinic for Geriatrics and Geriatric Medicine, Charité Medical Faculty Berlin, Berlin, Germany
| | - Robert Klebbe
- Clinic for Geriatrics and Geriatric Medicine, Charité Medical Faculty Berlin, Berlin, Germany
| | - André Maier
- Clinic for Neurology with Experimental Neurology, Charité Medical Faculty Berlin, Berlin, Germany
| | - Cornelia Eicher
- Forschungsgruppe Geriatrie, Charité Universitatsmedizin Berlin, Berlin, Germany
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Böttger T, Dennhardt S, Knape J, Marotzki U. "Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10465. [PMID: 36078184 PMCID: PMC9518532 DOI: 10.3390/ijerph191710465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.
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Affiliation(s)
- Tabea Böttger
- Institute of Health Science, Faculty of Medicine, University of Lübeck, 23562 Lübeck, Germany
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Holzminden, Göttingen (HAWK), 31134 Hildesheim, Germany
| | - Silke Dennhardt
- Physio- and Occupational Therapy Program, Faculty of Health, Alice Salomon Hochschule Berlin (ASH), University of Applied Sciences, 12627 Berlin, Germany
| | - Julia Knape
- Independent Researcher, 10439 Berlin, Germany
| | - Ulrike Marotzki
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Holzminden, Göttingen (HAWK), 31134 Hildesheim, Germany
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Barć K, Weber C, Maksymowicz-Śliwińska A, Ciećwierska K, Helczyk O, Ludolph C. A, Kuźma-Kozakiewicz M, Lulé D. Healthcare provision in amyotrophic lateral sclerosis: procedures, queries and pitfalls in Germany and Poland. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:193-202. [DOI: 10.1080/21678421.2020.1746345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Krzysztof Barć
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland,
| | - Christian Weber
- Institute of History, Philosophy and Ethics of Medicine, University of Ulm, Ulm, Germany,
| | | | | | - Olga Helczyk
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
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Funke A, Spittel S, Grehl T, Grosskreutz J, Kettemann D, Petri S, Weyen U, Weydt P, Dorst J, Ludolph AC, Baum P, Oberstadt M, Jordan B, Hermann A, Wolf J, Boentert M, Walter B, Gajewski N, Maier A, Münch C, Meyer T. Provision of assistive technology devices among people with ALS in Germany: a platform-case management approach. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:342-350. [DOI: 10.1080/21678421.2018.1431786] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andreas Funke
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Susanne Spittel
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Torsten Grehl
- Department of Neurology, Outpatient Center for ALS and other Motor Neuron Disorders, Alfried Krupp Krankenhaus, Essen, Germany,
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, University Hospital Jena, Jena, Germany,
| | - Dagmar Kettemann
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Susanne Petri
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany,
| | - Ute Weyen
- Department of Neurology, Outpatient Center for ALS and other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany,
| | - Patrick Weydt
- Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn, Bonn, Germany,
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany,
| | | | - Petra Baum
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany,
| | - Moritz Oberstadt
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany,
| | - Berit Jordan
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany,
- Research Site Dresden, German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany,
| | - Joachim Wolf
- Department of Neurology, Diakonissenkrankenhaus Mannheim, Mannheim, Germany,
| | - Matthias Boentert
- Department for Sleep Medicine and Neuromuscular Disorders, Universitätsklinikum Münster, Münster, Germany, and
| | - Bertram Walter
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | | | - André Maier
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
| | - Christoph Münch
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Thomas Meyer
- Outpatient Center for ALS and other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Berlin, Germany,
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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Kastrup M, Tittmann B, Sawatzki T, Gersch M, Vogt C, Rosenthal M, Rosseau S, Spies C. Transition from in-hospital ventilation to home ventilation: process description and quality indicators. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc18. [PMID: 29308061 PMCID: PMC5738500 DOI: 10.3205/000259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 10/16/2017] [Indexed: 12/14/2022]
Abstract
The current demographic development of our society results in an increasing number of elderly patients with chronic diseases being treated in the intensive care unit. A possible long-term consequence of such a treatment is that patients remain dependent on certain invasive organ support systems, such as long-term ventilator dependency. The main goal of this project is to define the transition process between in-hospital and out of hospital (ambulatory) ventilator support. A further goal is to identify evidence-based quality indicators to help define and describe this process. This project describes an ideal sequence of processes (process chain), based on the current evidence from the literature. Besides the process chain, key data and quality indicators were described in detail. Due to the limited project timeline, these indicators were not extensively tested in the clinical environment. The results of this project may serve as a solid basis for proof of feasibility and proof of concept investigations, optimize the transition process of ventilator-dependent patients from a clinical to an ambulatory setting, as well as reduce the rate of emergency re-admissions.
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Affiliation(s)
- Marc Kastrup
- Department of Anesthesiology and Operative Intensive Care Medicine, CCM/CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Tittmann
- Department for Hematology, Oncology and Palliative Care - Sarcoma Centre Berlin-Brandenburg, Bad Saarow, Germany
| | - Tanja Sawatzki
- Department of Anesthesiology and Operative Intensive Care Medicine, CCM/CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Gersch
- Freie Universität Berlin, School of Business & Economics, Department of Information Systems, Chair of Business Administration, Berlin, Germany
| | - Charlotte Vogt
- Freie Universität Berlin, School of Business & Economics, Department of Information Systems, Chair of Business Administration, Berlin, Germany
| | - Max Rosenthal
- Department of Anesthesiology and Operative Intensive Care Medicine, CCM/CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simone Rosseau
- Klinik Ernst von Bergmann Bad Belzig gGmbH, Bad Belzig, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, CCM/CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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