Evidence to Support the Need for Guidelines for the Provision of Assistive Technology

Sandra L Hubbard Winkler, PhD, OTR1,2 , Diane C Cowper Ripley, PhD1,3 , Helen Hoenig, MD4,5, Samuel Wu, PhD1,3 , Bruce Vogel, PhD1,3 , Shirley G Fitzgerald, PhD6 , William C Mann, PhD2 , Dean M Reker, PhD, RN7


1 Rehabilitation Outcomes Research Center (RORC) Research Enhancement Award Program (REAP), North Florida/South Georgia Veterans Health System Gainesville, FL
2 University of Florida, College of Public Health and Health Professions, Department of Occupational Therapy, Gainesville, FL
3 University of Florida, College of Medicine, Department of Epidemiology and Health Policy Research, Gainesville, FL
4 Durham VA Medical Center, Durham, NC
5 Duke University, Department of Medicine, Durham, NC
6 James A Haley Medical Center, Tampa FL
7 Edward Hines Jr. VA Medical Center, Hines, IL


The provision of AT should be based on patient need. Our research shows unexplained geographical variations in VHA AT delivery that cannot be explained by person-level factors such as diagnosis, severity of disability, or demographics. Of interest are factors that may explain this variation. Rather than asking who is using the technology, we asked if veterans received the same type/quality of technology across the VHA. Our objectives were to determine how: (1) Provision patterns vary for assistive devices for veterans post-stroke, by device and by geographic region and (2) Demographic/clinical characteristics, or geographic region are associated with provision of devices. For standard manual wheelchairs, for example, the amount of variation in device provision accounted for by regional effects is equivalent to the amount of variation accounted for by disability severity. Persistent geographical variation in provision of AT suggests the need for some type of standardization or guidelines concerning device provision.


Wheelchair, Scooter, Activities of daily living, Access


This work was funded by the VA Rehabilitation Research and Development Service (RR&D) Project #F3736R through the Rehabilitation Outcomes Research Center Research Enhancement Award Program (RORC REAP) at the North Florida/South Georgia Veterans Health System, Gainesville, FL. The findings and views in this article are those of the authors and do not necessarily represent those of the Veterans Administration.


Sandra L Winkler, PhD, OTR/L, ATP, RORC-REAP, No Florida/South Georgia Veterans Health System, 1601 SW Archer Rd  (151-B), Gainesville, FL  32608-1197, 352-376-1611, ext 4928, EMAIL: Sandra.Hubbard1@va.gov