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516 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE August 2016
Anno: 2016
Mese: August
Volume: 52
No: 4
Rivista: European Journal of Physical and Rehabilitation Medicine
Cod Rivista: Eur J Phys Rehabil Med
Lavoro: 4043-EJPRM
titolo breve: ABANDONMENT OFASSISTIVE TECHNOLOGY IN ITALY
primo autore: FEDERICI
pagine: 516-26
citazione: Eur J Phys Rehabil Med 2016;52:516-26
and the effects on the user’s family (e.g., the Family Im-
pact of Assistive Technology Scale 8). At present, there
is no standardized instrument for investigating AT aban-
donment although the phenomenon has been the subject
of surveys, particularly in the United States,9-17 but also
in Australia,18 Italy,19-21 and the Netherlands.22, 23
Despite some negative reasons affecting why AT
users abandon their devices (e.g., user’s health/physi-
cal condition worsening), there are also many neutral
Since Batavia and Hammer 1, 2 rst developed con-
sumer-based criteria for the evaluation of assistive
technology (AT) 3 a large number of tools 4 for measur-
ing AT outcomes have been developed. There are instru-
ments which evaluate user satisfaction (e.g., the Quebec
User Evaluation of Satisfaction with AT 5), the effective-
ness of AT (e.g., the Individual Prioritized Problem As-
sessment 6), the effects of an AT on the user’s life (e.g.,
the Psychosocial Impact of Assistive Devices Scale 7)
ORIGINAL ARTICLE
The abandonment of assistive technology in Italy:
a survey of National Health Service users
Stefano FEDERICI 1, Fabio MELONI 1, Simone BORSCI 2
1Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Perugia, Italy; 2Diagnostic Evidence
Cooperative Group of London, Imperial College, University of London, National Institute for Health Research, London, UK
*Corresponding author: Stefano Federici, Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Piazza G. Ermini 1,
06123 Perugia, Italy. E-mail: stefano.federici@unipg.it
ABSTRACT
BACKGROUND: This study was an extension of research which began in the Umbria region in 2009.
AIM: To investigate the extent to which assistive technology (AT) has been abandoned by users of the Italian National Health Service (ULHS)
and the reasons for this.
DESIGN: Observational study.
SETTING: Users who received a hearing device (HD) or mobility device (MD) by ULHS between 2010 and 2013.
POPULATION: 749 out of 3,791 ULHS users contacted via telephone completed the interview: 330 (44.06%) had a HD and 419 (55.94%) a
MD.
METHODS: Data were collected using a specially developed telephone interview questionnaire including the Italian version of the Quebec User
Evaluation of Satisfaction with AT (QUEST 2.0) and Assistive Technology Use Follow-up Survey (ATUFS).
RESULTS: 134 users (17.9%) were no longer using their assigned AT device within seven months of issue and 40% of this group reported that
they had never used the device. Duration of use (for how long the AT device was used before abandonment) and satisfaction with service delivery
did not predict AT abandonment. People who received a HD where more likely to abandon their device (22.4%) than those who received a MD
(14.4%).
CONCLUSIONS: Abandonment may be due to assignment of inappropriate devices or failure to meet user needs and expectations. These nd-
ings are consistent with previous data collected by Federici and Borsci in 2009. Utility of AT in use, reasons of abandonment, and importance
of device and service satisfaction for the use or non-use of an AT are presented and discussed. CLINICAL REHABILITATION IMPACT: AT
abandonment surveys provide useful information for modelling AT assessment and delivery process. The study conrms the relevance of person
centredness approach for a successful AT assessment and delivery process.
(Cite this article as: Federici S, Meloni F, Borsci S. The abandonment of assistive technology in Italy: a survey of National Health Service users. Eur
J Phys Rehabil Med 2016;52:516-26)
Key words: Self-help devices - Patient satisfaction - Surveys and questionnaires.
European Journal of Physical and Rehabilitation Medicine 2016 August;52(4):516-26
© 2016 EDIZIONI MINERVA MEDICA
Online version at http://www.minervamedica.it
COPYRIGHT© 2016 EDIZIONI MINERVA MEDICA
ABANDONMENT OF ASSISTIVE TECHNOLOGY IN ITALY FEDERICI
Vol. 52 - No. 4 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 517
Lavoro: 4043-EJPRM
titolo breve: ABANDONMENT OFASSISTIVE TECHNOLOGY IN ITALY
primo autore: FEDERICI
pagine: 516-26
citazione: Eur J Phys Rehabil Med 2016;52:516-26
countries.31 In Europe and Canada, healthcare is pro-
vided through a wide range of systems which are pri-
marily funded through taxation (universal health care),
whereas in the USA the health system is largely owned
and operated by private sector businesses. In Australia
and New Zealand, healthcare is delivered by a mix-
ture of public and private providers. Depending on the
economic model behind a health care system, a health
service user can be characterized as a user of a non-
commercial AT service, as a client of a commercial AT
provider, or as a patient of a medical center specializ-
ing in AT. The different types of service provision tend
to overlap, for example an AT user whose device was
provided by a specialist AT medical center might be a
patient both in private and public health systems. Fi-
nally, the cost of the AT to the user varies according to
the health system; it may be free of charge, covered by
insurance or paid for at the point of use by the user.
It has been shown that differences in health care
systems and AT service delivery models affect AT
outcomes. The Position Paper by the Association for
the Advancement of Assistive Technology in Europe
(AAATE) and European Assistive Technology Informa-
tion Network (EASTIN) stated that there is reliable evi-
dence that a badly designed AT delivery system results
in a high rate of non-use of AT and hence “waste of re-
sources, an unchanged situation in the person’s disabil-
ity, and frustration for the users”.32 Research has shown
that satisfaction with, and long-term use of AT increases
when, for instance, users are properly informed and
involved during the issuing process,13, 15, 33, 34 and the
health service provides active support and follow-up
after the device is issued.35 In a recent study, Federici
and Borsci 19 demonstrated that different AT service de-
livery strategies resulted in different rates of AT aban-
donment, ranging from 12.61% to 24.26%. The user’s
experience of an AT is affected not only by the quality
of his or her interaction with the AT, but also by the
quality of the assessment and selection process and the
delivery model.36
There are three other main factors which contribute
to the high reported variance in AT abandonment:19
1) differences in the samples of AT users (e.g., in terms
of age, disability, education, employment, etc.); 2) the
large differences in the type of device investigated;
3) lack of consensus on the denition of a threshold for
distinguishing between use and non-use.37
or positive reasons (e.g., health/physical condition im-
proving) justifying the disposal. Consistently, Lauer
et al.24 suggests a replacing the term “abandonment”
with “discontinuance”, which is considered as a more
encompassing term. Because the most common use in
literature is of the term ‘abandonment’ rather than other
synonyms, in this study we use abandonment as an um-
brella term for any non-use (positive or negative) of as-
signed AT, also in continuity with the study of Federici
and Borsci.19, 20
Abandonment has been investigated using specic
questions on AT use in face-to-face or telephone inter-
views. Phillips and Zhao 15 and Federici and Borsci 19, 20
investigated abandonment by asking users “Do you cur-
rently use this device?” and assessed the period of use
with the question “For how long [have you been using/
did you use] it?”. Similarly Bynum and Rogers9, Man et
al.,14 Riemer-Reiss and Wacker 16 measured abandon-
ment using the question “Are you still using your assis-
tive technology?” followed by a dichotomous response
choice. Dijcks et al.22 took a different approach, using a
multiple-choice question about non-use which asked re-
spondents whether they used their device “less”, “more”
or “about as much” as they had expected to. Wielandt et
al.18 asked respondents to use a ve-point Likert scale
to report how much they used their AT (from “none of
the time” to “all of the time”). Gitlin et al.,12 Cushman
and Scherer 10 and Kittel and colleagues13 used open
questions to collect information about current use of
AT. Most researchers have used open-choice questions
to elicit reasons for AT abandonment, although Phillips
and Zhao 15 and Federici and Borsci 19, 20 used multiple-
choice questions.
Most studies converge on an AT abandonment rate of
around 30% one year after device delivery.10, 15, 16, 18, 21
The 30% rate has been used as a threshold for dening
low and high rates of AT abandonment.16, 17, 23, 25 There
are, however, other reports of abandonment data which
are very different from each other and diverge from
the typical rate of abandonment.9, 11, 12, 14, 19-23, 26-30 Un-
doubtedly differences in methodology make it difcult
to compare studies, but this is not the only reason that
makes the abandonment rate so undened.
One factor which may contribute to the variance in
abandonment rates is the heterogeneity of AT service
delivery systems in regional and national health and so-
cial care, and across public and private providers within
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518 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE August 2016
users were asked to respond to a three-section question-
naire consisting of both open and closed questions.42
The questionnaire included the Italian versions of the
Assistive Technology Use Follow-up Survey (ATUFS)
1.1,43, 44 adapted to collect data on use and non-use of
AT, and the Quebec User Evaluation of Satisfaction
with Assistive Technology (QUEST).5 This research
was part of a project entitled “VITA - Visualizzazione
dell’Informazione e Tecnologie Assistive” (Information
visualization and AT) 45 promoted by the Department
of Health and Social Services of the Umbria Region in
2013 (DGR 328/13). This project is an extension of the
research on AT abandonment which began in the Um-
bria Region in 2009.19, 20
Subjects
AT services in Umbria are delivered via two units,
ULHS 1 and ULHS 2. In order to recruit a sample in
which we could assess whether users were still using
their device at least six months after issue we conducted
a retrospective search of users who had received an AT
from ULHS 1 or 2 between January 1, 2010 and May 31,
2013. The inclusion criteria were users who received a
MD (wheelchair: manual and powered; walking frame;
lifting person; stairlift) or HD; exclusion criteria were
age <18 years and age >85 years, and the year of AT
assignment, before January 2010 and after May 2013.
Selected users were interviewed by telephone between
December 2013 and September 2014.
The subjects —or their proxy —provided informed
consent to participation before the interview. No chil-
dren were enrolled. The study represented “no more
than minimal risk” to subjects.
Materials
The telephone interview questionnaire was developed
specically for this research 42 from tools developed by
Federici and Borsci 19, 20 for their previous survey of AT
abandonment in the Umbria Region. The questionnaire
is subdived in the three sections described below.
Section i (partS a and B)
The interviewer uses open and closed questions
to collect data to identify the user and the type of AT
Notwithstanding the variability in abandonment rates,
a large part of the scientic community agrees that AT
abandonment is the outcome of a complex interaction
of four main factors:37 1) personal factors (age, gender,
diagnosis, expectations, acceptance of disability, emo-
tional maturity/inner motivation, change in severity of
disability, etc.); 2) device factors (quality, appearance);
3) environment factors (social support, physical barri-
ers, etc.); 4) delivery factors (taking users’ opinions into
account, instruction and training, follow-up service,
etc.).
As Scherer and colleagues have already stated,4, 38-40
in order to minimize the risk of abandonment all these
factors have to be carefully managed, observed, and
assessed by the professionals involved in AT delivery
throughout the process of matching the user to the AT
device.
Purpose
The goal of this study was to investigate the extent
of AT abandonment among Italian National Health Ser-
vice users and the reasons for it. Subjects were recruited
from the population of patients who received a hearing
device (HD) or mobility device (MD) in the Umbria Re-
gion of Italy between 2010 and 2013.
The present research was conceived in the political
and economic context of rationalization of Italian pub-
lic spending policy. Since 2007, the Italian Council of
Ministers has adopted laws concerning revision of the
expenditures borne by Italian administrations, including
a number of provisions aimed at rationalizing and pos-
sibly reducing the expenses of the national healthcare
system. These national policies were also adopted by
the Health Care Plan of the Umbria Region.41 There-
fore, an investigation on the extent of AT abandonment
might provide relevant indications for the management
of the local health services of the Umbria Region.
Materials and methods
Data on rates and reasons for AT abandonment were
collected by surveying users who had received devic-
es through two different units of local health services
(ULHS) of the Umbria Region (hereafter ULHS 1 and
ULHS 2). The survey was carried out between Decem-
ber 2013 and September 2014. In a telephone interview
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ABANDONMENT OF ASSISTIVE TECHNOLOGY IN ITALY FEDERICI
Vol. 52 - No. 4 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 519
in touch with others?”). Responses are given on a Likert
Scale ranging from 1 (“not at all”) to 5 (“a lot”). This
section of the questionnaire concludes with item 16, an
open question about what might improve the usefulness
of the user’s current AT device.
If the respondent indicated at item 2 that he or she
was no longer using the device the interviewer moves
from item 4 to item 17, which consists of a scale with
21 sub-items investigating reasons for abandonment; it
covers the following reasons: ineffectiveness, unreli-
ability, difculty of operating the device (items #1, 6, 7,
9, 12, 13, 14, and 20); preference for, or necessity of hu-
man help (items #2 and #8); characteristics of the milieu
(item #3); changes in functional capacity (items #4 and
#5); interference with daily activities (item #17); nega-
tive attitudes (item #18); maintenance costs (item #19);
alternative solutions (item #21); appearance or size of
the device (items #10, 11, and 16); inadequate training
or support (item #15).
Section iii (part d)
Users’ satisfaction with AT is assessed using the Ital-
ian version of QUEST 2.0,5, 19, 20, 47 a twelve-item ques-
tionnaire which uses ve-point Likert scales (from “not
satised at all” to “very satised”) to capture the user’s
satisfaction with interactions with the device and with
the service provider. QUEST responses can be analyzed
in terms of subscale scores, i.e., Device (Q1 to Q8) and
services (Q9 to Q12), or total score. All scores are cal-
culated by averaging valid responses to relevant items.
Because the QUEST was also administered by Federici
and Borsci 19, 20 in their previous investigation of ULHS
users, we were able to compare the results of this study
with their earlier results.
Statistical analysis
Descriptive statistics (mean, standard deviation [SD])
were calculated to provide a prole of the sample. Infer-
ential statistics (one-way ANOVA, t-test, and chi-square
test) were used to compare subjects who received HDs
and MDs in terms of perceptions of the quality of UL-
HS’s AT service, rate and reasons of AT abandonment
(i.e., ATUFS), and satisfaction (i.e., QUEST scores).
Reasons for AT abandonment and user satisfaction with
the device and the service they received were analyzed
device issued (part A) and captures the user’s evalua-
tion of ULHS’s AT service (part B, item V3) using a
four-point Likert scale, ranging from 1 (“very bad”) to
4 (“excellent”). If the user gives a negative evaluation
(score of 1 or 2) of the ULHS’s AT service then ques-
tion V4 is administered to elicit the reasons. Items V1
and V2 in part B respectively capture information about
the number of visits to the ULHS’s AT service required
during the AT assignment process (response options: 2
to >5) and the user’s opinion of whether this number of
visits was appropriate (responses on a Likert scale rang-
ing from 1 [far too many]) to 5 [far too few]).
Section ii (partS c1 and c2)
The user’s experience with his or her AT device is
measured using the appropriate version of the ATUFS
(ATUFS-MD or ATUFS-HD; these differ only with
respect to items 10 and 11, which refer to specic de-
vice functions). The Italian versions were developed by
Federici et al.43, 44 from the original English version by
Scherer.46 ATUFS 1.1 (-MD and -HD) is a seventeen-
item questionnaire designed to capture the respondent’s
experience with an AT device he or she is using or the
reasons for having abandoned an AT device. Item 1 iden-
ties the brand of the device. Use is assessed with item
2: “Are you presently using this device?” (response op-
tions: “no”, “yes”). Phillips and Zhao,15 dened aban-
donment as non-use of an AT at the time of the survey.
This means that abandonment is recorded regardless of
whether the user has stopped using the device or never
used it. Items 3 and 4 investigate the duration and fre-
quency of AT use at present or before abandonment.
If the user responded positively to the question about
current use, the interview then proceeds with items 5 to
16. Items 5 and 6 investigate the user’s autonomy when
using the device, i.e. how often he or she needs help
when using the device and how often he or she uses the
device in a public context, respectively. Responses are
given on a Likert Scale ranging from 1 (“every time”) to
5 (“never”). The other nine items investigate the user’s
experience with the AT on three domains of daily life:
well-being and comfort (e.g., “To what degree [does/
did] the device enhance your well-being?), personal
care (e.g., “To what degree [does/did] the device help
you to take care of your health?”, and participation (e.g.,
“To what degree [does/did] the device help you to keep
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520 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE August 2016
the ULHS’s AT service (N.=74) was “It takes too long
[to get the AT device]” (mode: 26; 35.1%). T-tests indi-
cated that there were no differences between MD and
HD users and AT in use and abandoned with respect to
data in part B.
AT use and abandonment: ATUFS-MD and -HD, items
#1-4
Parts C1 and C2 of the telephone interview question-
naire consisted of the MD and HD versions of ATUFS
1.1 respectively. Item #1 gathered information about the
brand and model of the device to which other respons-
es related; these data are not relevant to this study and
are not reported. The majority of respondents (N.=615,
82.1%) indicated at item 2 that they were still using
their device. Abandonment of the device occurred on
average in the 7th month after issue. Among the 134
users (17.9%) who reported that they were no longer
using their assigned AT device the average duration of
use before abandonment was between 6 and 7 months
(the average time since device issue until the interview
was 32 months). There was a difference in the length of
time for which devices were used before abandonment
(t=4.67, P<0.001); MDs were used for longer than HDs
(mean 14 months and 3.5 months, respectively). Forty
percent of those recorded as having abandoned their AT
device reported that they had never used it. HD users
were more likely never to have used their device than
MD users (χ2(1,53)=26.84, P<0.001).
As expected, amongst current users there was a cor-
relation between the period of time that had elapsed
since AT issue and the reported frequency of AT use
(P<0.001); however, among ex-users there was no cor-
relation between time elapsed since issue and the dura-
tion of use before abandonment.
Autonomy and utility of AT in use: ATUFS-MD and
-HD, items #5-15
ATUFS items #5-16 were administered to the 615 us-
ers (82.1% of the sample) who reported that they were
still using their device; 358 (58.2%) were MD users and
257 (41.8%) were HD users.
MD users reported that they needed help to use their
device almost every time (item #5: mean 1.53±1.20)
and used their device in a public setting about half of
according to the scoring procedures for the relevant
questions.5, 43, 44 Cronbach’s α was calculated to pro-
vide a measure of the reliability of the Italian versions
of the scales. We also conducted correlation analyses to
evaluate relationships between AT service delivery, rea-
sons for AT abandonment, and satisfaction. All analyses
were carried out using SPSS Statistics v.23 (IBM Corp.,
Armonk, NY, USA).
Results
Sample
Seven hundred and forty-nine out of 3791 ULHS
users contacted via telephone completed the interview
(male: N.=287, 38%; female: N.=462, 62%; mean age
71.02 year, SD 13.94, range 18-85), a response rate of
19.76%. Roughly 45% of non-responses were house-
hold-level refusals (i.e., they occurred before the ap-
propriate respondent in the household could be deter-
mined 48) and 35% were respondent-level refusals (i.e.,
occurred after the appropriate respondent was identi-
ed 48). On average female respondents were older than
male respondents. There were no other gender differ-
ences with respect to the main dependent variables. In
35.38% of cases the respondent was the device user and
in 64.62% the respondent was a proxy; the older the
device user the more likely it was that the respondent
would be a proxy (one-way ANOVA, F=2.12, P<0.001).
Three hundred and thirty users (44.06%) had been
issued with a HD and 419 (55.94%) with a MD. The
most frequently issued MD was a wheelchair (N.=279,
66.59%; manual wheelchairs 85%; powered wheel-
chairs 15%).
Evaluation of ULHS’s AT service: telephone interview
questionnaire part B, items 1-4
Responses to the item about service delivery (V3)
indicated that 90.2% of users were satised (“quite sat-
ised” 74%; “very satised” 16.2%); only 9.8% of us-
ers declared themselves unsatised (“not very satised”
8.1%; “not at all satised” 1.7%). Satisfaction with the
AT service was negatively correlated with the number
of the visits required during AT assignment (item V1;
P<0.001) and with user opinion about the appropriate-
ness of the number of visits (item V2; P<0.001). The
reason most commonly given for dissatisfaction with
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health (item #14: mean 4.10±1.07) or personal errands
(item #12: mean 4.16±1.18).
An independent-samples t-test revealed that HD us-
ers were signicantly more satised overall with their
device than MD users (t=12.65, P<0.001; total score for
ATUFS items #7-15).
The open question about suggestions for improving
device utility (item #16) prompted many suggestions
from users on features and options that might improve
practical utility of their devices. In view of the volume
of qualitative data gathered, we plan to discuss them in
a future work.
Reasons for non-use of AT: ATUFS-MD and -HD sub-
items #17.1-17.21
ATUFS item #17 was administered to subjects
(N.=134, 17.9%) who reported that they were not using
the assigned device; 74 (55.2%) were HD users and 60
(44.8%) were MD users. The AT non-use was 22.4% for
HD, whereas 14.4% for MD. ATUFS item #17 consists
of a scale with 21 sub-items that showed good internal
consistency (Cronbach’s α=0.79).
Scores on sub-items #1-21 were dichotomized into
low importance (scores ≤5) and high importance (scores
≥6) categories. Means, standard deviations and catego-
ry frequencies for all items are reported in Table II.
the time (item #6: mean 2.67±1.81). HD users did not
need help to use their device (item #5: mean 4.20±1.40)
and reported that they wore their device every time
they went out into the community (item #6: mean
1.24±0.68).
The items dealing with device utility (items #7-15)
showed good internal consistency (ATUFS-MD: Cron-
bach’s α=0.76; ATUFS-HD: Cronbach’s α=0.89).
Scores on items 7-15 were dichotomized into low
utility (scores ≤3) and high utility (scores ≥4) catego-
ries. Mean values, standard deviations and category fre-
quencies for all items are reported in Table I.
The mean overall utility reported by MD users was
greater than the midpoint on the response scale (total
score: mean 3.51±0.83). They also reported that the de-
vice was very useful in helping them to get around their
home (item #10: mean 4.15±1.32) and that it greatly im-
proved their quality of life (item #7: mean 4.00±1.13).
Conversely MD users considered their device more or
less useless for helping them to take care of personal er-
rands (item #12: mean 2.37±1.60) or travelling one mile
outdoors (item #11: mean 2.85±1.77).
HD users reported that their device was very use-
ful (Total score: mean 4.30±0.66). It was reported to
be most useful for helping users communicate with the
people they were living with (item #10: mean 4.46±0.80)
and was considered least useful for taking care of their
taBle i.—Current AT users’ assessment of the utility of their device (ATUFS-MD and -HD items #7-15).
ATUFS-MD and -HD on AT utility (items #7-15)
Mobility device Hearing device
Low utility
(score ≤3)
High utility
(score ≥4) Mean (SD) Low utility
(score ≤3)
High utility
(score ≥4) Mean (SD)
7. To what degree does (did) the device improve your quality of life? 22.6% 77.4% 4.00 (1.13) 14.8% 85.2% 4.29 (0.84)
8. To what degree does (did) the device enhance your comfort? 28.8% 71.2% 3.85 (1.19) 13.6% 86.4% 4.27 (0.80)
9. To what degree does (did) the device enhance your well-being? 26.5% 73.5% 3.90 (1.16) 13.2% 86.8% 4.27 (0.82)
10. To what degree does (did) the device help you to… get around one
oor of where you live (to communicate with those who live with
you or attend daily)*?
22.1% 77.9% 4.15 (1.32) 12.1% 87.9% 4.46 (0.80)
11. To what degree does (did) the device assist you to… move one mile
outdoors (to communicate outside of your home environment)*?
57% 43% 2.85 (1.77) 12.1% 87.9% 4.42 (0.81)
12. To what degree does (did) the device help you to take care of
personal errands?
66.2% 33.8% 2.47 (1.60) 20.2% 79.8% 4.16 (1.18)
13. To what degree does (did) the device help you to keep in touch with
others?
41.9% 58.1% 3.50 (1.46) 11.3% 88.7% 4.42 (0.86)
14. To what degree does (did) the device help you to take care of your
health?
42.5% 57.5% 3.45 (1.42) 20.6% 79.4% 4.10 (1.07)
15. To what degree does (did) the device help you be more active and
involved in the community and with other people?
43.9% 56.1% 3.45 (1.51) 10.9% 89.1% 4.37 (0.87)
Total score 3.51 (0.83) 4.30 (0.66)
*Question wording in parentheses applies to HD users.
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ing (item #17.15: t=2.45, P<0.05), and replacement with
a better device (item #17.21: t=2.92, P<0.01) were sig-
nicantly stronger reasons for abandonment among MD
users.
QUEST 2.0
QUEST 2.0 was administered to all subjects (N.=749)
regardless of whether they were still using their device.
The scale as a whole and the Device subscale showed
good internal consistency (α=0.84 and 0.85, respective-
ly), but internal consistency was weaker for the Service
subscale (α=0.67).
The scores obtained were dichotomized into low
satisfaction (scores ≤3) and high satisfaction (scores
≥4) categories. Category frequencies for all items and
means and standard deviations for both subscales and
the scale as a whole are reported in Table III.
MD users who were still using their device re-
ported signicantly higher satisfaction than users
who had abandoned their device in terms of Total
score (t=5.90, P<0.001) and Device score (t=6.78,
P<0.001), but not Service score. HD users who were
MD users reported that they abandoned the device
mainly because they needed a better or different device
(item #17.14: mean 4.22±4.63), because their health
or physical condition had worsened (item #17.4: mean
3.77±4.78), or because it had been replaced with a bet-
ter device (item #17.21: mean 3.70±4.68). The main
reasons given by HD users for no longer using, or never
having used their device were that the device wasn’t the
right design for them (item #17.10: mean 5.34±4.53),
or did not meet their basic needs (item #17.16: mean
3.77±4.20) and that they needed a better or different de-
vice (item #17.14: mean 3.74±4.45).
Independent-sample t-tests were carried out to assess
the differences between MD and HD users in terms of
reasons for abandoning an AT device. Wrong design of
device (item #17.10: t=-3.17, P<0.01) and embarrass-
ment when using it (item #17.18: t=-2.83, P<0.01) were
signicantly stronger reasons for abandonment among
HD users. Preferring human help (item #17.2: t=2.04,
P<0.05), and worsening of health or physical condition
(item #17.4: t=3.07, P<0.01), or an improvement in health
or physical condition (item #17.5: t=3.35, P=0.001), lack
of human help (item #17.8: t=2.01, P<0.05), lack of train-
taBle ii.—Reasons for non-use of AT (ATUFS-MD and -HD sub-items #17.1-17.21).
ATUFS-MD and -HD
sub-items #17.1-17.21
Mobility device Hearing device
Low
importance
(score ≤5)
High
importance
(score ≥6)
Mean (SD) Low
importance
(score ≤5)
High
importance
(score ≥6)
Mean (SD)
17.1. It was part of another device or system that I stopped using. 93.3% 6.7% 0.52 (1.99) 97.3% 2.7% 0.23 (1.13)
17.2. I prefer to have someone help me rather than use the device. 86.7% 13.3% 1.60 (3.28) 91.9% 8.1% 0.65 (2.08)
17.3. An important change in the make-up of my family. 95% 5% 0.45 (2) 100% 0% 0.12 (0.74)
17.4. My health/physical condition got worse. 61.7% 38.3% 3.77 (4.78) 85.1% 14.9% 1.58 (3.44)
17.5. I no longer needed to use it because my health/physical condition
got better.
86.7% 13.3% 1.35 (3.38) 100% 0% 0.03 (0.23)
17.6. It stopped working properly. 85% 15% 1.38 (3.37) 90.5% 9.5% 1.07 (2.76)
17.7. It was too inconvenient to use. 83.3% 16.7% 1.75 (3.39) 77% 23% 2.07 (3.69)
17.8. There was no one to help me use it. 93.3% 6.7% 0.68 (2.35) 100% 0% 0.11 (0.67)
17.9. It did not work as I expected it would. 80% 20% 1.92 (3.68) 81.1% 18.9% 1.93 (3.69)
17.10. It was not the right design for me. 71.7% 28.3% 2.88 (4.34) 41.9% 58.1% 5.34 (4.53)
17.11. It was not the right size for me. 76.7% 23.3% 2.50 (4.08) 75.7% 24.3% 2.31 (3.85)
17.12. It was too uncomfortable to use. 63.3% 36.7% 3.43 (4.39) 78.4% 21.6% 2.23 (3.94)
17.13. It was too painful to use. 95% 5% 0.47 (2.06) 87.8% 12.2% 1.07 (2.76)
17.14. It did not help me because I needed a better or different device. 55% 45% 4.22 (4.63) 60.8% 39.2% 3.74 (4.45)
17.15. I did not get the training or support I needed to use it. 91.7% 8.3% 0.98 (2.56) 98.6% 1.4% 0.18 (1.09)
17.16. It did not suit my basic needs. 70% 30% 3.33 (4.13) 54.1% 45.9% 3.77 (4.20)
17.17. It interfered too much with my normal routines and patterns of
doing things.
86.7% 13.3% 1.32 (3.13) 79.7% 20.3% 1.84 (3.50)
17.18. I felt self-conscious using it. 95% 5% 0.47 (1.96) 79.7% 20.3% 1.89 (3.47)
17.19. The lease/rental expired and I could not afford it. 100% 0% 0.10 (0.54) 97.3% 2.7% 0.22 (1.35)
17.20. It broke and I cannot use it. 90% 10% 0.97 (2.93) 93.2% 6.8% 0.69 (2.43)
17.21. I replaced it with a better device. 63.3% 36.7% 3.70 (4.68) 83.8% 16.2% 1.59 (3.66)
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(item V1) negatively correlated with QUEST Service
score (P<0.001) and QUEST Total score (P<0.05).
Correlations between ATUFS and QUEST scores
To analyze the relationship between the subjects’ ex-
periences with AT and their satisfaction with it we per-
formed a Pearson’s correlation analysis for data from
ATUFS 1.1 (MD and HD versions) and the QUEST
scales.
Within current MD users there were strong correla-
tions (0.001<P<0.007) among all items of ATUFS, ex-
cept for items #10 and #11, and QUEST total and device
scales. Among current HD users there were strong cor-
relations (P<0.001) between all the ATUFS items and
both QUEST total and QUEST device scores; ATUFS
items #17.7 and #17.9 were also weakly correlated
(P<0.05) with QUEST Service score.
Among ex-MD users there were high negative cor-
relations (0.000<P<0.01) between ATUFS sub-items
#17.7, 17.9, 17.10, 17.11, 17.12, 17.14, 17.16, and
17.18, and both QUEST total and QUEST device scores.
In addition, ATUFS sub-items #17.10, 17.11, and 17.18
were weakly correlated (0.002<P<0.013) with QUEST
service score. There were no negative correlations be-
tween ATUFS sub-items #17.1 to 17.21 and the QUEST
scores in former HD users.
still using their device were signicantly more sat-
ised than users who had abandoned their device
in terms of total score (t=13.98, P<0.001), device
score (t=13.72, P<0.001), and service score (t= 9.21,
P<0.001).
When the analysis was restricted to subjects who
were still using their device HD users reported higher
satisfaction than MD users in terms of both total score
(t=-2.87, P<0.01) and service score (t=-8.61, P<0.001),
but there was a similar level of satisfaction in terms of
device score. Users who had abandoned a MD had been
signicantly more satised with it overall than users
who had abandoned a HD (total score: t=2.31, P<0.05),
but this group difference applied only to the device it-
self (device score: t=2.65, P<0.01) and not the service
associated with it.
Correlations between user evaluation of ULHS’s AT
service and QUEST scores
Among current AT users there was a signicant cor-
relation between user evaluation of the ULHS’s AT ser-
vice (item V3) and scores on the Device and Service
subscales of QUEST (P<0.001). Among ex-users the
item V3 score was only correlated with QUEST Ser-
vice score (P<0.01). Only in current AT users was the
reported number of visits needed to obtain the device
taBle iii.—Satisfaction with the mobility device (MD) or hearing device (HD) issued (QUEST 2.0 scores).
QUEST 2.0
Users with AT in use Users with abandoned AT
MD low
satisfaction
(score ≤3)
MD high
satisfaction
(score ≥4)
HD low
satisfaction
(score ≤3)
HD high
satisfaction
(score ≥4)
MD low
satisfaction
(score ≤3)
MD high
satisfaction
(score ≥4)
HD low
satisfaction
(score ≤3)
HD high
satisfaction
(score ≥4)
Q1. Dimension 24.3% 75.7% 25.3% 74.7% 40% 60% 75.7% 24.3%
Q2. Weight 19.6% 80.4% 7.8% 92.2% 36.7% 63.3% 63.5% 36.5%
Q3. Ease in adjusting 12.3% 87.7% 14.4% 85.6% 30% 70% 68.9% 31.1%
Q4. Safe/secure 7.3% 92.7% 13.6% 86.4% 33.3% 66.7% 75.7% 24.3%
Q5. Durability 14.5% 85.5% 27.6% 72.4% 28.3% 71.7% 74.3% 25.7%
Q6. Ease in use 9.5% 90.5% 5.4% 94.6% 25% 75% 66.2% 33.8%
Q7. Comfort 13.4% 86.6% 12.5% 87.5% 40% 60% 77% 23%
Q8. Effectiveness 11.2% 88.8% 16% 84% 45% 55% 79.7% 20.3%
Device scale percentage 3.4% 96.6% 1.9% 98.1% 28.3% 71.7% 64.9% 35.1%
Device scale mean score 4.24±0.57 4.18±0.49 3.63±0.99 3.28±0.53
Q9. Service delivery 28.5% 71.5% 31.9% 68.1% 31.7% 68.3% 73% 27%
Q10. Repairs and servicing 68.4% 31.6% 15.6% 84.4% 71.7% 28.3% 64.9% 35.1%
Q11. Professional services 20.1% 79.9% 6.6% 93.4% 28.3% 71.7% 63.5% 36.5%
Q12. Follow-up 70.1% 29.9% 30% 70% 75% 25% 78.4% 21.6%
Service scale percentage 18.7% 81.3% 5.1% 94.9% 25% 75% 64.9% 35.1%
Service scale mean score 3.62±0.71 4.09±0.58 3.43±0.73 3.35±0.67
Total mean score 4.04±0.52 4.15±0.44 3.57±0.80 3.30±0.51
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524 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE August 2016
former HD users, whose reasons for abandonment tend-
ed to be directly related to the device characteristics,
their abandonment may not have been related to their
judgment of the device. The QUEST scores indicated
that all groups of users except current HD users were
relatively unsatised with the AT service. This suggests
that HD users were less likely to abandon their device
if the assessment and issuing procedure and follow-up
service were perceived as a satisfactory pathway.
We did not investigate the ULHS’s AT assessment pro-
cesses, but Federici and Borsci 19, 20 reported that the user ex-
perience of an AT is inuenced by the quality of the service
they received in relation to the device. In the Umbria Region
HD users can obtain a HD through two different pathways:
through the ULHS’s AT service or through commercial cen-
ters operated by HD manufacturers (e.g., Maico, Amplifon,
etc.). Users who follow the latter pathway are entitled to
have the cost of their HD refunded by the ULHS, although
post-delivery support and follow-up are provided by the
commercial centers. The differences in satisfaction with the
AT service may be related to the use of different pathways.
Furthermore, given that both current and ex-MD users ex-
pressed a lack of satisfaction with their AT service similar
to that of former HD users, we suggest that current HD us-
ers — who reported higher satisfaction with the support and
follow-up they received in relation to their device — are
more likely to have bought their device from a commercial
center. HD users who obtained their device from a commer-
cial center reported better initial and post-delivery service
than users who received their AT from the ULHS’s service.
Two factors may account for the inuence of quality of
service on user satisfaction and non-acceptance.19-21 First,
greater satisfaction with the ULHS’s AT service (QUEST
Service score) was negatively associated with number of
visits required to obtain the AT device (questionnaire part B,
item V1). Second, duration of use before abandonment and
satisfaction with the service did not predict abandonment,
suggesting that it might instead be related to the character-
istics of the device issued (AT assessment process 36) or to
failure of the device to meet user needs and expectations
(matching person and technology 4). Corroboration for
these suggestions comes from the fact that 40% of recorded
ex-users reported that they had never used the device issued
to them and the majority of the remainder had abandoned
their device with 7 months of issue.
Data on the utility of the AT (ATUFS-MD and -HD,
items #7-15) showed that the most valued functions
Discussion
We found that overall 17.9% of our sample had aban-
doned their device; this is lower than the generally accept-
ed 30% abandonment rate.10, 15, 16, 18, 21 The abandonment
seemed to be motivated almost exclusively by negative
reasons as displayed in Table II. Only the MD users found
that they no longer needed to use AT because their health/
physical condition got better, and for a very low percent-
age (item #17.5, high importance 13.3%). This suggests
the appropriate use of “abandonment” (with a negative
emphasis) rather than, e.g., “discontinuance” in reference
to AT non-use. Users who received a HD were more like-
ly to abandon their AT (22.4%) than people who received
a MD (14.4%). We found that a higher percentage of HD
users had never used the device issued to them and those
who had used it had used it for a signicantly shorter
period than those who had abandoned a MD. The most
commonly given reason for not using a HD was that the
design of the device was inappropriate (58%). Reasons
for abandoning MDs were more various and none was
highly important to the majority of ex-users. However,
summing the frequencies of the two mutually exclusive
health-related reasons (items #17.4 and #17.5) indicated
that for 52% of MD users (N.=31) health reasons were a
very important factor in their abandonment of their de-
vice. In summary, it seems that a personal factor (health)
was a more important factor in non-use of MDs than tech-
nology- and service-related factors, in spite of the fact
that satisfaction with AT service delivery was rather low.
Conversely, among ex-HD users the main reasons given
for abandonment or lack of use were the AT assessment
process and the features of the device. Similar ndings
have been reported by Phillips and Zhao,15 Bynum and
Rogers,9 Cushman and Scherer,10 and Verza et al.,21 all
of whom cited poor device performance, changes in user
needs or functional capacity, and alternative solutions as
reasons for abandonment.
Analysis of the QUEST scores from ex-HD users pro-
duced unexpected results. Although former HD users
reported low satisfaction with their device and the asso-
ciated service, former MD users reported similar levels
of satisfaction to MD users who were still using their
device. A possible explanation for this difference is that
MD users were more likely than HD users to have aban-
doned their device for health reasons (positive or nega-
tive change in health) than because of factors related to
the device or the AT service. This means that unlike the
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ABANDONMENT OF ASSISTIVE TECHNOLOGY IN ITALY FEDERICI
Vol. 52 - No. 4 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 525
estimated AT abandonment rate of 17.9%, the economic
leakage was around € 3,363,015.73. If we consider that
the population of Umbria is roughly 900,000 inhabit-
ants, this is a relevant sum, especially in light of the
Italian public spending policies since 2007.
Federici and Borsci 49 demonstrated that the AT de-
livery systems in the Umbria Region Local Health Ser-
vice, which is oriented to a more “person-centered” (i.e.,
individualized and holistic) approach, involving users
in decisions about the support they receive,6, 29, 45 have
fewer functional problems, more satised users, and a
lower AT abandonment rate. Conversely, in AT deliv-
ery with systems which are less focused on optimizing
the process — i.e., reducing the costs, time, and profes-
sionals’ efforts — the number of problems that a user
could experience interacting with service is higher, user
satisfaction is lower, and the AT abandonment rate is
higher. Given that, we also found a correlation between
user evaluation of ULHS (i.e., user satisfaction with AT
delivery system) and QUEST scores (user satisfaction
with AT in use): our ndings suggest relevant indica-
tions for the ULHS management. A spending review fo-
cusing only on the efciency (minimization of the time
and costs of the process) of the health care systems and
neglecting their effectiveness (quality of both process
and solution provided to the patient) would be non-eco-
nomic in the long-term and, therefore, not truly efcient.
References
1. Batavia AI, Hammer GS. Toward the development of consumer-
based criteria for the evaluation of assistive devices. J Rehabil Res
Dev 1990;27:425-36.
2. Batavia AI, Dillard D, Phillips B, editors. How to avoid technology
abandonment. 5th Annual Conference on Technology and Persons
with Disabilities. Los Angeles, CA: California State University; 1990.
3. Weiss-Lambrou R. Satisfaction and Comfort. In: Scherer MJ, editor.
Assistive Technology: Matching Device and Consumer for Success-
ful Rehabilitation. Washington, DC: American Psychological Asso-
ciation; 2002. p. 77-94.
4. Corradi F, Scherer MJ, Lo Presti A. Measuring the Assistive Technol-
ogy Match. In: Federici S, Scherer MJ, editors. Assistive Technology
Assessment Handbook. London, UK: CRC Press; 2012. p. 49-65.
5. Demers L, Monette M, Lapierre Y, Arnold DL, Wolfson C. Reli-
ability, validity, and applicability of the Quebec User Evaluation of
Satisfaction with assistive Technology (QUEST 2.0) for adults with
multiple sclerosis. Disabil Rehabil 2002;24:21-30.
6. Wessels RD, Persson J, Lorentsen Ø, Andrich R, Ferrario M, Oortwi-
jn W, et al. IPPA: Individually Prioritised Problem Assessment. Tech-
nol Disabil 2002;14:141-5.
7. Jutai J, Day H. Psychosocial Impact of Assistive Devices Scale (PI-
ADS). Technol Disabil 2002;14:107-11.
8. Ryan S, Campbell KA, Rigby P, Germon B, Chan B, Hubley D. De-
velopment of the new Family Impact of Assistive Technology Scale.
Int J Rehabil Res 2006;29:195-200.
were enhanced quality of life (item #7) and help in the
home environment (item #10). Current HD users were
more satised (ATUFS and QUEST scores) than cur-
rent MD users. The QUEST data suggest that this dif-
ference in satisfaction was due to a difference in sat-
isfaction with the service received in relation to one’s
device. This is further evidence to suggest that the type
of service provision, rather than device characteristics,
determines overall satisfaction.
Limitations of the study
This study has several limitations. One relates to the
representativeness of the sample. Although the research
is based on the largest survey ever conducted on AT
abandonment in Italy, the sample was not selected to be
representative of the population using the ULHS’s AT
service in terms of demographic and clinical variables.
Second, unlike Federici and Borsci,19, 20 we did not in-
vestigate the AT assessment processes of each ULHS’s
AT service, although this aspect of service delivery has
been shown to affect the outcome of AT issue.13, 19, 20, 36
Third, we did not control for the effect of the choice of
device provider (commercial center vs. ULHS) on the
outcome of AT issue; we did not collect data on whether
users had received their device from the ULHS’s AT
service or from a commercial center. Finally, the study
was restricted to only two types of devices (mobility and
hearing devices); including other classes of AT might
have affected the global percentage of abandonment.
Conclusions
The goal of this study was to investigate the extent
and reasons for AT abandonment among Italian ULHS
users. At the time of the survey 134 (17.9%) out of 749
respondents declared that they were not using their AT
device and 40% of this group reported that they had
never used the device issued to them. Our data suggests
that abandonment may be the result of issuing of an in-
appropriate device, or unmet user needs and expecta-
tions. These ndings are in line with data gathered in
2009 by Federici and Borsci.19, 20 Finally, we would also
like to highlight the economic leakage caused by AT
abandonment in the Umbria Region. In 2013, the Um-
bria Region spent € 18,787,797.37 on AT; assuming an
COPYRIGHT© 2016 EDIZIONI MINERVA MEDICA
FEDERICI ABANDONMENT OF ASSISTIVE TECHNOLOGY IN ITALY
526 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE August 2016
30. Hocking C. Function or feelings: factors in abandonment of assistive
devices. Technol Disabil 1999;11:3-11.
31. Federici S, Scherer MJ. Preface. In: Federici S, Scherer MJ, editors.
Assistive Technology Assessment Handbook. Boca Raton, FL: CRC
Press; 2012. p. xv-xviii.
32. AAATE, EASTIN. Service delivery systems for assistive technology
in Europe: position paper; 2012 [Internet]. Available from: http://
www.aaate.net/ [cited 2015 Jun 15].
33. Martin JK, Martin LG, Stumbo NJ, Morrill JH. The impact of con-
sumer involvement on satisfaction with and use of assistive technol-
ogy. Disabil Rehabil 2011;6:225-42.
34. Borg J, Larsson S, Östergren P-O, Rahman A, Bari N, Khan A. User
involvement in service delivery predicts outcomes of assistive tech-
nology use: a cross-sectional study in Bangladesh. BMC Health Serv
Res 2012;12:330.
35. Hansen R, Tresse S, Gunnarsson RK. Fewer accidents and better
maintenance with active wheelchair check-ups: a randomized con-
trolled clinical trial. Clin Rehabil 2004;18:631-9.
36. Federici S, Scherer MJ, editors. Assistive technology assessment
handbook. Boca Raton, FL: CRC Press; 2012.
37. Wessels RD, Dijcks BPJ, Soede M, Gelderblom GJ, De Witte LP.
Non-use of provided assistive technology devices, a literature over-
view. Technol Disabil 2003;15:231-8.
38. Scherer MJ, editor. Assistive technology: matching device and con-
sumer for successful rehabilitation. Washington, DC: American Psy-
chological Association; 2002.
39. Scherer MJ. Living in the state of stuck: How technologies affect
the lives of people with disabilities. Fourth edition. Cambridge, MA:
Brookline Books; 2005.
40. Scherer MJ, Sax CL, Vanbiervliet A, Cushman LA, Scherer JV. Pre-
dictors of assistive technology use: The importance of personal and
psychosocial factors. Disabil Rehabil 2005;27:1321-31.
41. Regione Umbria. Piano sanitario regionale 2009/2011 (Atto num. 298
del 28-04-2009). Bollettino Ufciale 2009;25(Suppl):1-428.
42. Federici S, Meloni F, Borsci S. Assistive Technology Use and Satisfac-
tion Questionnaire (ATUSQ) for telephone interview 2013 [Internet].
Available from: www.researchgate.net/publication/280942287_Assis-
tive_Technology_Use_and_Satisfaction_Questionnaire_(ATUSQ)_
for_Telephone_Interview [cited 2016 Jun 15].
43. Federici S, De Luca E, Corradi F. ATUFS 1.1. Italian version. Follow-
up sull’uso della Tecnologia Assistiva per ICT (a 12 e 24 mesi); 2015
[Internet]. Available from: http://doi.org/10.13140/RG.2.1.1261.5840
[cited 2016 Jun 15].
44. Federici S, Corradi F. ATUFS 1.1. Italian version. Follow-up sull’uso
della Tecnologia Assistiva per la Mobilità (a 24 mesi); 2015 [Inter-
net]. Available from: http://doi.org/10.13140/RG.2.1.4014.0963 [cit-
ed 2016 Jun 15].
45. Federici S, Mele ML, Romeo SA, Didimo W, Liotta G, Borsci S, et
al. A Model of Web-based Follow-up to Reduce Assistive Technology
Abandonment. In: Kurosu M, editor. Human-Computer Interaction Ap-
plications and Services. Berlin, DE: Springer; 2014. p. 674-82.
46. Scherer MJ. The Matching Person & Technology (MPT) Model Man-
ual and Assessments [CD-ROM]. Fifth edition. Webster, NY: The
Institute for Matching Person & Technology, Inc.; 2005.
47. Demers L, Weiss-Lambrou R, Ska B. The Quebec User Evaluation of
Satisfaction with Assistive Technology (QUEST 2.0): An overview
and recent progress. Technol Disabil 2002;14:101-5.
48. Bauman SL. Refusal Rate. In: Lavrakas P, editor. Encyclopedia of Sur-
vey Research Methods. Los Angeles, CA, US: SAGE; 2008. p. 707-8.
49. Federici S, Corradi F, Meloni F, Borsci S, Mele ML, Dandini de Sylva
S, et al. A Person-Centered Assistive Technology Service Delivery
Model: A Framework for Device Selection and Assignment. Life
Span Disab 2014;17:175-98.
9. Bynum HS, Rogers JC. The Use and Effectiveness of Assistive Devic-
es Possessed by Patients Seen in Home Care. OTJR 1987;7:181-91.
10. Cushman LA, Scherer MJ. Measuring the Relationship of Assistive
Technology Use, Functional Status Over Time, and Consumer Thera-
pist Perceptions of ATs. Assist Technol 1996;8:103-9.
11. Geiger CM. The utilization of assistive devices by patients discharged
from an acute rehabilitation setting. Physical & Occupational Thera-
py in Geriatrics 1990;9:3-25.
12. Gitlin LN, Levine R, Geiger CM. Adaptive device use by older adults
with mixed disabilities. Arch Phys Med Rehabil 1993;74:149-52.
13. Kittel A, Di Marco A, Stewart H. Factors inuencing the decision to
abandon manual wheelchairs for three individuals with a spinal cord
injury. Disabil Rehabil 2002;24:106-14.
14. Mann WC, Granger C, Hurren D, Tomita M, Charvat B. An analysis
of problems with canes encountered by elderly persons. Physical &
Occupational Therapy in Geriatrics 1995;13:25-49.
15. Phillips B, Zhao H. Predictors of Assistive Technology Abandon-
ment. Assist Technol 1993;5:36-45.
16. Riemer-Reiss ML, Wacker R. Factors associated with assistive tech-
nology discontinuance among individuals with disabilities. J Rehabil
2000;66:44-50.
17. Riemer-Reiss ML, Wacker RR. Assistive technology use and aban-
donment among college students with disabilities. International Elec-
tronic Journal for Leadership in Learning 1999;3:1-15.
18. Wielandt T, Mckenna K, Tooth L, Strong J. Factors that predict the
post-discharge use of recommended assistive technology (AT). Disa-
bil Rehabil Assist Technol 2006;1:29-40.
19. Federici S, Borsci S. Providing assistive technology: the perceived
delivery process quality as affecting abandonment. Disabil Rehabil
Assist Technol 2016;11:22-31.
20. Federici S, Borsci S. The use and non-use of assistive technology in
Italy: a pilot study. In: Gelderblom GJ, Soede M, Adriaens L, Miesen-
berger K, editors. Everyday technology for independence and care:
AAATE 2011. Amsterdam: IOS Press; 2011. p. 979-86.
21. Verza R, Carvalho ML, Battaglia MA, Uccelli MM. An interdiscipli-
nary approach to evaluating the need for assistive technology reduces
equipment abandonment. Mult Scler 2006;12:88-93.
22. Dijcks BPJ, De Witte LP, Gelderblom GJ, Wessels RD, Soede M.
Non-use of assistive technology in The Netherlands: a non-issue?
Disabil Rehabil Assist Technol 2006;1:97-102.
23. De Craen AJM, Westendorp RGJ, Willems CG, Buskens ICM,
Gussekloo J. Assistive devices and community-based services among
85-year-old community-dwelling elderly in The Netherlands: Owner-
ship, use, and need for intervention. Disabil Rehabil Assist Technol
2006;1:199-203.
24. Lauer A, Longenecker Rust K, Smith RO. ATOMS Project technical
report - Factors in assistive technology device abandonment: Replac-
ing “abandonment” with “discontinuance”; 2006 [Internet]. Available
from: www.r2d2.uwm.edu/atoms/archive/technicalreports/tr-discon-
tinuance.html [cited 2016 Jun 10].
25. Scherer MJ. Outcomes of assistive technology use on quality of life.
Disabil Rehabil 1996;18:439-48.
26. Steel DM, Gray MA. Baby boomers‘ use and perception of recom-
mended assistive technology: a systematic review. Disabil Rehabil
Assist Technol 2009;4:129-36.
27. Gitlin LN. Why older people accept or reject assistive technology.
Generations 1995;19:41-6.
28. Holm MB, Rogers JC. High, low, or no assistive technology devices
for older adults undergoing rehabilitation. International Journal of
Technology and Aging 1991;4:153-62.
29. Rogers JC, Holm MB. Assistive technology device use in patients
with rheumatic disease: a literature review. Am J Occup Ther
1992;46:120-7.
Funding.—This work was supported by funding received from the Department of Health and Social Services of the Umbria Region in 2013 (DGR 328/13).
Conicts of interest.—The authors certify that there is no conict of interest with any nancial organization regarding the material discussed in the manuscript.
Article rst published online: January 19, 2016. - Manuscript accepted: January 14, 2016. - Manuscript revised: January 8, 2016. - Manuscript received:
August 14, 2015.
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