OptiMalisation and efficiency of the provision process of Assistive Technology devices for the ARM hand function ("OptiMalisatie en doelmatigheid van het verstrekkingsproces van hulpmiddelen voor ARM- en handfunctie" in Dutch)

OBJECTIVE: To optimise the process of providing Assistive Technology (AT) devices for the arm-hand function and to evaluate effects and cost-effectiveness. Restrictions on arm and hand function, e.g. due to muscle disease or CVA, can have a major impact on independence. AT for arm and hand function is advised by for example occupational therapists and physiotherapists to increase independence. This research focuses on dynamic arm supports and robotic arms. At the moment, AT for the arm-hand function is not optimally used. Users often have a device that does not fit in well with their wishes and needs. Not every AT is suitable for everyone. In addition, clients and professionals often do not know about the existence of the AT devices. There is therefore room for improvement in the provision of these AT devices. In addition, there is very little insight into their (cost) effectiveness. In order to determine effectiveness, it is essential that the provision process runs smoothly, resulting in an optimal match between the user and the device.
METHOD: A quasi-experimental study with enrolment of the control group in year 1 and enrolment of the intervention group in year 2 (non-randomized, consecutive inclusion of control and intervention group). Recruitment takes place through involved care institutions and AT suppliers. In the intervention group, the provision of AT for the arm-hand function takes place in accordance with the optimised working method laid down in the protocol to be developed. Protocol development takes place in 6 meetings together with stakeholders including health insurance companies, suppliers, care professionals and end users. The protocol follows the steps described in the RiFA. After development, the protocol is implemented in the participating healthcare organisations and the suppliers. For this purpose, a post-HBO course will be developed and given in the project, and the protocol and associated tools will be made available digitally.
CARE AS USUAL: Earlier research has provided insight into bottlenecks in the current method of providing AT devices for the arm-hand function. The process currently is not standardised; not everyone who would benefit is entering the process, professionals do not have sufficient knowledge about the AT devices, the cooperation between client, supplier and care professional often does not go well, the match between AT device, client and environment is often not sufficient, the delivery period is quite long and the evaluation is limited.
ECONOMIC EVALUATION: According to Dutch guidelines as a combination of CEA and CUA from a social perspective. In the CEA, the ICER is expressed as the incremental costs per improvement on the D-QUEST. Primary outcome measure CUA: QUALY based on the EQ-5D-5L. Data are collected with a constructed questionnaire.

An optimized provisioning process leads to more satisfaction with the AT and the associated service provision. Participants in the intervention group score higher on the sub-scores of the D-QUEST (primary outcome measure) than the participants in the control group. The scores for the secondary outcome measures, such as the IPPA, KWAZO, DASH and EQ-5D-5L, also show greater positive effects than the scores in the control group. The optimized method could lead to higher costs when using the device (e.g. by realizing a trial period, more time for instruction and training and careful evaluation). However, a better match between the individual user and the device reduces the non-use of the provided devices and prevents over- and under-supply.

Primary and secondary outcomes are measured at (0), 3, 6, and 9 months of use of the device. The process of provision is also monitored.

AT for arm-hand function, specific dynamic arm supports and robotic arms are the focus of this research. These AT devices have been provided in the Netherlands since 2006 via the Healthcare Insurance Regulations (Section 1.4 Assistive Technology, Articles 2.6 and 2.12). A protocol is being developed to optimise the provision of care. This protocol is applied in the intervention group.