Effectiveness of provision of outdoor mobility services and devices in the Netherlands

• Published in: Clinical rehabilitation 2004-06, Vol.18 (4), p.371-378
• Main Authors: Wessels, R D, de Witte, L P, Jedeloo, S, van den Heuvel, W PM, van den Heuvel, W JA
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Disability; Disabled people; Disabled Persons; Effectiveness; Female; Humans; Male; Mobility; Motor Vehicles; National Health Programs; Netherlands; Outdoor activities; Participation; People with disabilities; Program Evaluation; Quality of Life; Service provision; Technical aids; Transportation of Patients - methods; Wheelchairs
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1191/0269215504cr755oa

Objective: To answer the following questions: What are the problems encountered by people with outdoor mobility disabilities? What solutions are being offered to them in the Netherlands? How effective are these solutions? How responsive is the IPPA instrument (Individually Prioritized Problem Assessment)? Design: Analysing the results of a follow-up study using the IPPA instrument. Setting: The Dutch Service for the Disabled Act (SDA, in Dutch: WVG) provision system. This act is responsible for the provision of mobility aids and home adaptations. Subjects: Fifty-nine people with outdoor mobility disabilities. Interventions: The provision of outdoor mobility service and devices. Main outcome measures: Effectiveness of provisions as measured using IPPA (i.e., the degree to which activities have become less difficult to perform), effect size of IPPA with this intervention. Results: Problems identified by clients are very diverse and specific but can be classified fairly well on the basis of the International Classification of Functioning, Disability and Health (ICF); in the main, the solutions they are provided with are very similar and generic. Effectiveness is excellent at a group level, but insufficient for some at an individual level. The IPPA instrument is highly responsive in this setting. Most mobility problems respondents identified, although very individual and specific, were related to shopping, social visits or leisure activities. These specific sets of problems were solved using ‘standard’, generic solutions. Conclusions: The Dutch provision system should be more ‘demand oriented’ and less ‘supply oriented’. IPPA turns out to be a useful, structured and individualoriented method to evaluate service delivery.