When the Evidence Is Thin: Making Sound Decisions About Assistive Technology

By the time a study is published, the technology being studied may have changed. Or the research may involve a small group of users whose needs don’t quite match those of the person you’re working with. So, what do you do when the evidence doesn’t give you a clear answer?

Consider a power wheelchair user with progressive weakness who is having difficulty controlling a standard joystick. An alternative drive control may offer a solution, but there may be little research comparing different options for someone with their specific abilities and needs.

It’s tempting to go one of two directions: dismiss an option because the evidence is limited or assume it will work because the technology seems promising. Neither approach tells us much about whether it will actually help the person in front of you.

Start with what you know

Evidence-based practice brings together the best available research, clinical expertise, and the individual’s values and preferences (Bennett & Bennett, 2000).

When direct research is limited, studies involving similar technologies or populations may offer useful information. But we need to be clear about where the evidence ends and our assumptions begin.

For the wheelchair user in our example, we might expect that a different drive control could reduce the physical effort needed to operate the chair. But that doesn’t tell us whether the person can use it consistently, manage fatigue, or navigate their environment effectively. Those questions still need answers.

Make the trial count

An equipment trial is an opportunity to test our clinical reasoning, not just demonstrate product features.

Before the trial, consider what success would look like. Does the person want to navigate their home with less effort? Drive longer distances without fatigue? Maintain independent mobility as their abilities change?

Then observe what happens during the trial. Can the person operate the control accurately and consistently? Does performance change with fatigue, positioning, or the environment? How does the user feel about the experience?

A single trial won’t replace a well-designed study, but it can provide useful information for an individual decision. And sometimes the result is that the technology isn’t the right fit. That’s useful information, too.

Working with uncertainty

Limited evidence doesn’t mean we abandon evidence-based practice. It means we need to be more deliberate about how we apply it. The question isn’t simply whether a technology has enough research behind it. It’s whether the available evidence, clinical reasoning, and individual assessment provide a sound basis for trying it—and then using what we learn from the outcome to guide the decision in front of us and inform future ones (Jordan et al., 2019).

Putting It into Practice

Think back to an AT trial that didn’t go as expected. What surprised you? Did the outcome challenge an assumption or change how you approached a similar situation later? Sometimes what we learn is just as valuable as what we set out to evaluate.