be few instruments in this database based on a wider understanding of quality of life or which are appropriate for a general population, including both disabled and non-disabled people and people in different states of health. This is consistent with the tendency of some researchers in the area to use the terms quality of life and general health status interchangeably and to assume that a multiple item health status questionnaire can provide a satisfactory measure of quality of life (McDowell and Newell 1996).

Another approach used in the medical context defines quality of life as the gap between an individual’s hopes and expectations and their actual experiences (Calman 1984). This approach has the advantage of including subjective elements and being defined by the individual rather than the researcher. However, there is the associated disadvantage that hopes and expectations are difficult to measure and a preference for the use of definitions which can be quantified and measured. Quality of life scales based on the Calman approach have been developed and include the Schedule for the Evaluation of the Individual Quality of Life (O’Boyle et al. 1992, 1993), which is also available in a shorter form, SEIQoL-DW (Browne et al. 1994; Hickey et al. 1996). In this shorter form, the quality of life scale is uniquely defined for each individual, as it is based on the five quality of life domains that they consider the most important (Mountain et al. 2004).

1.2.4 Assistive Technology Quality of Life Procedures

Six different assistive technology specific outcome measures and one ongoing project are reviewed and discussed. These different approaches have been influenced to different extents by health quality of life approaches and a universal standard approach has not yet been developed. Although most of the measures and procedures have been tested both through studies of their performance with different groups of end-users and by experts, there is a need for more comparative studies of the different methods.

1.2.4.1 Life-H

Life-H aims to measure the quality of social participation in terms of the manner in which daily activities and social roles, called life habits, are carried out and with regards to any disruption of these life habits. It uses measures of social participation based on the concept of ‘life habits’, defined as ‘habits that ensure the survival and development of a person in society throughout life’ (Noreau et al. 2002). It includes essential activities, such as eating and sleeping, activities which are carried out daily, such as personal hygiene and getting out of bed, and other activities based on a mixture of choices and available options, such as social activities, interpersonal relationships and employment. These life habits have been divided into twelve categories (Fouygerollas et al. 1998).

The LIFE-H assessment consists of two different questionnaires, a short version for general screening and a longer version for more detailed assessment of specific areas of social participation. The assessment is based on the level of difficulty in

10 1 Disability and Assistive Technology Systems

performing a life habit (activity) and the type of assistance, for instance an assistive device or human assistance, required and marked on a scale with a continuum of 10 levels. Levels of satisfaction with the accomplishment of each activity are measured on a five-point scale. Activities which are not part of a person’s lifestyle from choice are excluded from the assessment. The questionnaire can either be self-administered or form part of an interview. The time required is 30–60 min for the short form and 20–120 min for the long form, depending on the number of categories of life habits being investigated. There is also a version for children (5–13 years old) where life habits considered irrelevant to children, such as parental roles, sexual relationships and employment, have been eliminated.

LIFE-H can be used to investigate the impact of assistive technology by comparison of assessments with and without the technology. However, its use as an outcome measure has been relatively limited. It is available in French and English versions, with plans for translation into Spanish, German, Dutch and Italian. Modifications may be required to ensure that it is appropriate in all countries worldwide (Fouygerollas et al. 1998).

1.2.4.2 OT FACT

OT (occupational therapy) FACT (Smith 2002) is a software-based assessment approach to measuring ‘function’ rather than quality of life. It was originally intended to be used by occupational therapists and aimed at measures of ‘functionality’ in terms of both observed ‘performance’ and subjective scoring by the user of their satisfaction with this performance. Question branching is used to investigate areas in which the respondent experiences difficulties or barriers (unfortunately referred to in the literature as ‘deficits’). Only issues scored ‘1’ to indicate some barriers are investigated further. The other two possibilities are ‘0’ for no barriers and ‘2’ for impossible to overcome barriers. A version called time series concurrent differential (TSCD) methodology is used to investigate the impact of assistive technology by comparing performance with and without assistive technology. The question branching approach is useful. However, both the software and the inherent philosophy based on ‘deficits’ are becoming dated.

1.2.4.3 Psychosocial Impacts of Assistive Devices Scale (PIADS)

The PIADS (Day and Jutai 1996; Day et al. 2002; Jutai and Day 2002) is a 26-item self-report questionnaire that aims to assess the effects of assistive device use on functional independence, wellbeing and quality of life. It is divided into three sub-scales:

1.Competence (12 items), which measures feelings of competence and efficacy and includes questions on competence, productivity, usefulness, performance and independence.

2.Adaptability (6 items), which measures willingness to try out new things and take risks, and includes questions on participation, willingness to take chances,

eagerness to try new things and the ability to take advantage of opportunities. It is intended to be sensitive to the enabling and liberating aspects of assistive technology.

3.Self-esteem (8 items), which measures feelings of emotional health and happiness and includes questions on self-esteem, security, sense of power, and control and self-confidence. It is intended to be sensitive to the perceived impact of assistive technology on self-confidence and emotional wellbeing.

Responses to each question can range from −3 (most negative impact) to +3 (most positive impact), with zero representing no perceived impact. The questionnaire can generally be completed in 5–10 min. PIADS is currently available in English and translation into other languages, as well as production of versions for children and people with cognitive impairments is being investigated.

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

QUEST 2.0 is intended to evaluate satisfaction with a wide range of assistive technology (Demers et al. 2002a,b), expressed in a linear general framework (Simon and Patrick 1997). Satisfaction is defined in QUEST as ‘a person’s critical evaluation of several aspects of a device’ and may be influenced by expectations, perceptions, attitudes and personal values. Expressed satisfaction is considered a reaction to assistive technology provision and may also affect behaviour, for instance through the use of or abandonment of an assistive device.

The initial version of QUEST consisted of 24 items, with responses on 5-point importance and satisfaction scales from ‘of no importance’ to ‘very important’ and ‘not satisfied at all’ to ‘very satisfied’ respectively. As a result of field-testing (Demers et al. 1999a,b), the importance scale was removed, as it did not discriminate reliably between and among assistive technology users and the questionnaire was reduced to 12 items rated on a 5-point satisfaction scale. The items are divided into the following two scales (Demers et al. 2000):

•Device scale, consisting of the following eight items: comfort, dimensions, simplicity of use, effectiveness, durability, adjustments, safety and weight.

•Services scale, consisting of the following four items: professional service, followup services, repairs/servicing and service delivery.

The scores over all the items on each of these scales, as well as over all the items, are averaged to produce average scores for device satisfaction, satisfaction with the associated services and total satisfaction. QUEST was originally developed in Canadian English and French and has been translated into Dutch, Swedish, Norwegian, Danish and Japanese.

1.2.4.5 Matching Person and Technology (MPT)

MPT is an assessment procedure for use in determining outcomes and the appropriate assistive technology for a particular person in a given environment (Scherer

12 1 Disability and Assistive Technology Systems

and Craddock 2002). It is based on the matching person and technology model (Scherer 2000; Scherer and Cushman 2000), which is divided into the three main components of the person using the technology, the technology and the milieu or environment.

Two versions have been developed in Ireland and the U.S., with the U.S. version translated into French and Italian. There is also a version for children under 15, known as the matching assistive technology and child (MATCH) version. The procedure is generally performed with the technology user and provider working together. A range of different types of assessments is available and personnel who are trained and experienced in the procedure can carry out assessments in 15–45 min.

The following six-step procedure is used, with the first three steps relating to the questionnaires and the last three to discussion of outcomes and the resulting action to be taken:

1.Using the MPT worksheet to determine ‘limitations’ in areas such as communication and mobility and initial goals of the service provider and end-user. Potential interventions and the technologies required to support the goals are indicated on the form.

2.The Technology Utilisation Worksheet is used by the end-user and service provider together to record technologies used in the past, satisfaction with them and the technologies the user wants or needs, but has not yet received.

3.The end-user completes their version of the appropriate form for the type of technology (general, assistive, educational, workplace or healthcare) being considered. Alternatively, if appropriate, an oral interview is carried out. The provider completes their version of the same form and identifies any differences between the two forms. The assistive technology device predisposition assessment (ATDPA) asks users about their subjective satisfaction in functional areas (9 items), asks them to prioritize the aspects of their lives they most want to improve (12 items), profiles their psychosocial characteristics (33 items) and asks for their views on 12 aspects of using a particular type of assistive device. The service provider’s form aims to enable the service provider to evaluate incentives and disincentives to the user using a given device.

4.The service provider discusses factors with the user that could indicate problems with acceptance or appropriate use of the technology.

5.The user and service provider discuss specific intervention strategies and draw up an action plan to address the problems.

6.The strategies and action plan are written down to increase their likelihood of being implemented and, if required, to provide documentary support for requests for funding or release time for training.

All the forms, except the healthcare form, have two versions for the service provider and end-user respectively, which are intended to be used together to identify characteristics of the person, environment or technology that could lead to inappropriate use or abandonment. The user is required to focus on current