Environment

Disability is no longer understood as a feature of the individual, but rather as the outcome of an interaction of the person with a health condition and the environmental factors. The environment consists of the physical, social and attitudinal circumstances in which people live and conduct their lives. Environmental factors are external to the individual and can have a positive or negative influence on a person's participation as a member of society, on performance of activities, or on a person's body function or structure. Facilitators are features of the environment that have a positive effect on disability while barriers are features of the environment that have a negative effect on disability.

There are very few measurement tools designed to evaluate the environment and its effect on an individual’s life. The physical environment is the most commonly assessed aspect that is evaluated. In this section we feature two environmentally oriented tools that have been validated with individuals with SCI.

The outcome measures reviewed under this category include:

Assistive Technology Device Predisposition Assessment (ATD-PA)

The ATD-PA examines consumer’s subjective satisfaction with achievements in a variety of functional areas. Consumers are asked to characterize aspects of functioning, temperament, lifestyle, and views of a particular assistive device (Scherer & Cushman 2001).

Number of items: 63 (divided into 2 domains)

Domain one contains 53 itemsand is designed to be administered across several time points. It is divided into four sectionss:
- Section A (items 1-9) asks respondents to rate their current capabilities in nine functional areas on a five-point scale (1=poor to 5=excellent).
- Sections B and C inquire about quality of life. Each item is rated on a five-point scale (Section B: 1=not satisfied; 5=very satisfied; Section C: 1=strongly disagree; 5=strongly agree).
- Section D contains 33 statements about temperament and psychosocial support. Patients check those which apply to them.
Domain two is designed to be administered for each assistive technology device used across several time points. It consists of 10 items related to the expected benefit from a device. Patients rate each item on a five-point scale based on how much the statement applies to them (1=does not apply to me; 5=definitely applies to me).

Procedure/Administration: Self report or interview.

Interpretability: Scores from the quality of life section provide information regarding the consumer’s subjective quality of life. Higher scores are indicative of better quality of life. No information is available regarding norms or meaningful cut scores.

Acceptability: The ATD-PA has been shown to be a reliable measure and to have adequate content and criterion-related validity in the SCI population

Languages: N/a

Usability: N/a

Time to administer: Likely has considerable time burden.

Time to score: N/a

Training required: N/a

Availability: N/a

Equipment required: N/a

Summary:

The ATD-PA encourages consumer participation in the process of developing and setting goals and helps the consumer to better understand her or his own needs and interests. It is useful when a consumer has a complicated case, and is a good tool for assessing a client’s ‘story’ with assistive technology.
The ATD-PA has the potential to contribute to the formulation of consumer-directed needs and goals. For persons with new SCI who indicate a predisposition to poor assistive technology use, the ATD-PA can be a measure to identify obstacles to AT use.

Psychometric Summary

Reliability

Validity

Responsiveness

Results

Floor/ceiling

IC: Green light

Construct: Green light

Criterion: Yellow light

N/a

Note: TR= Test re-test; IC= Internal Consistency; Inter-O= Inter-observer; Intra-O= Intra-observer; SS= Sensitivity/Specificity; N/a= No information.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

References

Scherer MJ and Cushman LA. Determining the content for an interactive training programme and interpretive guidelines for the Assistive Technology Device Predisposition Assessment. Disability and Rehabilitation 2002; 24: 126-130.

Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0)

The QUEST was designed to evaluate a person’s satisfaction with a wide range of assistive technology (AT) (Demers et al. 2002). The current version of the scale covers two dimensions: satisfaction with the device and satisfaction with the service from the vendor/manufacturer.

Number of items: 12

Procedure/Administration: The tool has a self-administration or interview format. Response categories range from 1 (not satisfied at all) to 5 (very satisfied).

How scored: The QUEST yields three scores: Device, Services, and a total score. All scores are calculated by summing and then averaging valid responses to assigned items.

Interpretability: Higher scores indicate a higher level of satisfaction. No information on important cut points or responsiveness (sensitivity to change) is available.

Acceptability: Reliability and validity studies for SCI have only been conducted with the Chinese version of the QUEST. In the self-administered format, the QUEST demands minimal skills to circle or mark the responses on the rating scale and to write comments. When the interview format is used, some interactive optional material is provided, including a list of 12 satisfaction items printed in large font and an enlarged rating scale displaying the 5-point degrees of satisfaction.

Languages: English, French, and Chinese.