Use of technology by orientation and mobility professionals in Australia and Malaysia before COVID-19

Cost-benefit analysis of orientation and mobility programs for adults with vision disability: a contingent valuation study

PURPOSE

The purpose of this study is to conduct a cost-benefit analysis of orientation and mobility (O&M) programs from three perspectives: the general public, the experienced, and the potential users of O&M programs.

METHODS

Willingness-to-pay (WTP) for O&M programs was collected via a contingent valuation survey using a double-bound dichotomous choice approach. WTP was estimated using interval regression analyses, accounting for study arm, sex, occupation, income, and self-rated health. The cost data were estimated from a service provider's perspective. The net present value (NPV), variation if delivered by tele-O&M, was investigated.

RESULTS

The adjusted mean NPV of O&M programs was $3857 (95% CI: $3760-$3954) per client, with highest NPV from the general public ($4289, 95% CI: $4185-$4392), followed by the experienced users ($3158, 95% CI: $2897-$3419) and the potential users ($2867, 95% CI: $2680-$3054). The NPV reached break-even for tele-O&M.

CONCLUSIONS

There was strong community support for investment into O&M programs considering benefits for clients over and above the cost of providing the services.Implications for rehabilitationThis study demonstrates the feasibility of using cost-benefit analysis with a contingent valuation approach to economically assess a rehabilitation intervention, where its multi-dimensional benefits cannot be fully captured by a conventional appraisal technique such as cost-effectiveness analysis.The high willingness-to-pay (WTP) values amongst the general public suggests that Australians perceive government's investment in orientation and mobility (O&M) rehabilitation as value for money and that individuals would be prepared to contribute to its costs.The lower WTP for O&M partially delivered via tele-practice (tele-O&M) indicates a lower acceptance of this innovation in comparison with the traditional face-to-face O&M.The estimated net present values of O&M programs, positive for traditional O&M and break-even for tele-O&M, can be of assistance to service planning and investment decisions within the Australian context.

Rehabilitation Care at the Time of Coronavirus Disease-19 (COVID-19) Pandemic: A Scoping Review of Health System Recommendations

Purpose: The coronavirus disease-19 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. COVID-19, caused by SARS-CoV-2 has imposed a significant burden on health care systems, economies, and social systems in many countries around the world. The provision of rehabilitation services for persons with active COVID-19 infection poses challenges to maintaining a safe environment for patients and treating providers. Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. Study Selection: We included articles and reports if they were focused on rehabilitation related recommendations for COVID-19 patients, treating providers, or the general population. Data Extraction: Pairs of team members used a pre-tested data abstraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: We retrieved 6,468 citations, of which 2,086 were eligible for review, after duplicates were removed. We excluded 1,980 citations based on title and abstract screening. Of the screened full-text articles, we included all 106 studies. A summary of recommendations is presented. We assessed the overall evidence to be strong and of fair quality. Conclusion: The rehabilitation setting, and processes, logistics, and patient and healthcare provider precaution recommendations identified aim to reduce the spread of SARS-CoV-2 infection and ensure adequate and safe rehabilitation services, whether face-to-face or through teleservices. The COVID-19 pandemic is rapidly changing. Further updates will be needed over time in order to incorporate emerging best evidence into rehabilitation guidelines.

Use of technology by orientation and mobility professionals in Australia and Malaysia before COVID-19

PURPOSE

Orientation and Mobility (O&M) professionals teach people with low vision or blindness to use specialist assistive technologies to support confident travel, but many O&M clients now prefer a smartphone. This study aimed to investigate what technology O&M professionals in Australia and Malaysia have, use, like, and want to support their client work, to inform the development of O&M technologies and build capacity in the international O&M profession.

MATERIALS AND METHODS

A technology survey was completed by professionals (n = 36) attending O&M workshops in Malaysia. A revised survey was completed online by O&M specialists (n = 31) primarily in Australia. Qualitative data about technology use came from conferences, workshops and interviews with O&M professionals. Descriptive statistics were analysed together with free-text data.

RESULTS

Limited awareness of apps used by clients, unaffordability of devices, and inadequate technology training discouraged many O&M professionals from employing existing technologies in client programmes or for broader professional purposes. Professionals needed to learn smartphone accessibility features and travel-related apps, and ways to use technology during O&M client programmes, initial professional training, ongoing professional development and research.

CONCLUSIONS

Smartphones are now integral to travel with low vision or blindness and early-adopter O&M clients are the travel tech-experts. O&M professionals need better initial training and then regular upskilling in mainstream O&M technologies to expand clients' travel choices. COVID-19 has created an imperative for technology laggards to upskill for O&M tele-practice. O&M technology could support comprehensive O&M specialist training and practice in Malaysia, to better serve O&M clients with complex needs.Implications for rehabilitationMost orientation and mobility (O&M) clients are travelling with a smartphone, so O&M specialists need to be abreast of mainstream technologies, accessibility features and apps used by clients for orientation, mobility, visual efficiency and social engagement.O&M specialists who are technology laggards need human-guided support to develop confidence in using travel technologies, and O&M clients are the experts. COVID-19 has created an imperative to learn skills for O&M tele-practice.Affordability is a significant barrier to O&M professionals and clients accessing specialist travel technologies in Malaysia, and to O&M professionals upgrading technology in Australia.Comprehensive training for O&M specialists is needed in Malaysia to meet the travel needs of clients with low vision or blindness who also have physical, cognitive, sensory or mental health complications.