Abstract
Introduction: Standing routine is a known beneficial daily activity for both healthy and disabled persons, especially those with permanent lower limb paralysis. However, the prescription of standing device for adults with permanent paralysis was inadequate and non-standard in existing local practice because of lack of good design and evidence based funding support. Objective: In view of the availability of new advances in power standing device, we aim to perform an effective health technology assessment (HTA) from professional and users perspectives to develop the decision pathway in prescription for long term home use. Methodology: A functional test and social cost analysis was performed on one high cost new standing mobile devices in recent market. A practical workshop and surveys were performed to collect feedback from 24 healthcare professionals and 8 expert users on a spectrum of new standing mobile device. Results: From the survey results, there was consensus among all participants that ‘Standing’ as daily routine at home is essential and beneficial. 62.5% of healthcare professionals would provide training to users and their cares to facilitate users to perform standing at home. Eight factors were identified from factor analysis in affecting the choice of standing devices for home use by healthcare professionals and users. Users scored high (mean=9.25/10) in “compliance with the new power standing mobile device”. The cost analysis showed considerable savings in social costs in using even the high-cost power standing mobile device. Discussion: The group welcomed power standing device with or without mobile function to support their standing activity at home. A possible clinical decision for prescribing different standing devices with identified factors was summarized. Conclusion: More recent researches have reported the negative health issues associated with prolonged sitting. With more innovative product designs, the power standing devices with or without mobile function is a new concept welcomed by both healthcare professionals and users in promotion of their health, preventing complications as well as independent living in home environment. A larger scale of HTA with structured cost-effectiveness analysis is essential to inform the healthcare resources planners.
Highlights
Standing routine is a known beneficial daily activity for both healthy and disabled persons, especially those with permanent lower limb paralysis
Every step included one or more searching & data management tools, which are essential and necessary for the implementation procedure. These steps were summarized as follows: (1): Work Team Establishment for a Preliminary Assessment—Pre-Evaluation Panel; (2): Selection or Rejection of the proposed technology, on the basis of the pre-evaluation made in step1. (3): Identification of Key Areas / Key Informants where additional information / evidence is required. (4): Comparison of New Information arising from step 3 with that used in the initial decision. (5): Assessment of possible Conflicts. (6): Decision to Terminate or to Proceed, repeating steps 3-5. (7): Detailed Evaluation and report. 2.1 Evidence Building The principle investigator organized a pre-evaluation panel (PEP) of 4 persons who were the seniors and specialists in the Centre relevant in the delivery of the intervention “Standing”
In exploring the current practice among the healthcare professionals, 62.5% of them would provide training to users and their cares to facilitate users to perform standing at home after hospital discharge
Summary
Standing routine is a known beneficial daily activity for both healthy and disabled persons, especially those with permanent lower limb paralysis. Objective: In view of the availability of new advances in power standing device, we aim to perform an effective health technology assessment (HTA) from professional and users perspectives to develop the decision pathway in prescription for long term home use. Health Technology Assessment (HTA) “improves the uptake of cost-effective new technologies in local settings It prevents the uptake of technologies that are of doubtful value for the health system” (WHO, 2011) Prescription of assistive device to improve and maintain health of persons with chronic disabilities & prevention of unnecessary interventions or admissions due to secondary complications was imminent in view of increasing volume of permanent wheelchair users globally. An effective standing schedule was described as at least 5 times per week, 30 minutes duration and 5 times a week This was suggested for improvement in outcomes such as self-care, standing balance, range of motion, strength, spasticity, pain, skin integrity and bowel/bladder functioning (Hohman, 2011). While another recommendation of 60 minutes 4-6 times a week for improvement in bone mineral density and mental status was stated (Paleg, Smith, & Glickman, 2013)
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