Assistive Technology Outcomes Research: Contributions to Evidence-Based Assistive Technology Practice
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چکیده
All over the world a vast number of persons with disability use assistive devices in order to enable everyday activities and to improve their quality of life (QoL). The development of assistive technologies (AT) rapidly increases the range of solutions for users. There is, however, a scarcity of knowledge concerning the effectiveness of different AT, e.g. which types of devices and services function best for which groups of users and during what circumstances? Such knowledge is of great importance and in demand by persons with disability in need of an assistive device; practitioners delivering AT services, e.g. occupational therapists, speech pathologists, and rehabilitation engineers; and service providers such as public administrations, private assistive technology services, and politicians. Similar challenges are seen within health care and other public services. This is why in the 1990s the notion of evidence-based medicine was launched by a research group led by David Sackett at McMaster University in Canada. The aim was to increase the efficiency and effectiveness of treatments and since then evidencebased practice (EBP) has gained tremendous attention within health care and at a later time also within social services. Over the years, EBP has been subject of criticism in turn leading to further development and is now seen as a contribution to clinical reasoning alongside the patient’s preferences and the clinician’s experiences when making decisions about health care interventions. In addition, in some countries scientific evidence of interventions’ effectiveness is used for priority setting purposes. Thus, it is urgent that the scientific evidence is trustworthy and up-to-date. This poses several research challenges in general, and for AT outcomes research a number of specific challenges, some of which are highlighted in this Special Issue of Technology and Disability. When assessing the quality of evidence a hierarchy of research designs is utilised. Most hierarchies state that conclusions based on systematic reviews of randomized controlled trials (RCTs) are considered to provide the highest level of evidence about the effectiveness of an intervention. Systematic reviews use objective means of searching the literature and apply predetermined inclusion and exclusion criteria, critical appraisal, data extraction and synthesis to formulate findings. The RCT design is considered to be the most trustworthy design, as this design minimises the risk of bias and increases the internal validity. However, use of the design has a number of limitations, e.g. RCTs cannot always be used due to ethical reasons, because external validity is often poor since results do not always apply to real life situations, and because RCTs are too expensive. The first article by Anttila and colleagues in this Special Issue of Technology and Disability reports on a comprehensive overview of systematic reviews of effectiveness of AT and additionally assesses the research quality. In the light of the difficulties in applying RCT, the authors expected to identify only a few systematic reviews, but ended up with 44 articles, giving an overview of the state of the art. On the one hand more articles than expected were published, but on the other hand no articles about the effectiveness of most AT were found. Especially evidence on AT for children and young people was missing, and likewise outcomes regarding daily activities and participation at work, home and during leisure time were rarely investigated. Most available reviews concerned information and communication technology. The quality of the ev-
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