Quebec User Evaluation of Satisfaction with Assistive Technology

Purpose

The QUEST 2.0 evaluates a patient's satisfaction with various assistive technologies.

Link to Instrument

Instrument Details

Acronym QUEST 2.0

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

The original QUEST (Version 1.0) can be found in:
Demers, L., Weiss-Lambrou, R., et al. (1996). "Development of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)." Assist Technol 8(1): 3-13.

Diagnosis/Conditions

Arthritis + Joint Conditions
Brain Injury Recovery
Cerebral Palsy
Parkinson's Disease & Movement Disorders
Pulmonary Disorders
Spinal Cord Injury
Stroke Recovery
Vestibular Disorders

Spinal Injuries

Older Adults and Geriatric Care

Non-Specific Patient Population

Multiple Sclerosis

Wheelchair Usage

12 item instrument used to assess satisfaction with a specific assisitive device; eight of these items assess characteristics of that assistive device in terms of the following dimensions:
1) Dimensions (size)
2) Weight
3) Adjustments
4) Safety
5) Durability
6) Simplicity of use
7) Comfort
8) Effectiveness
The remaining four items assess service and include:
1) Service delivery
2) Repairs and service of the device
3) Professionalism of service
4) Follow-up service
Participants are asked to rate their satisfaction for the device on a five point scale that ranges from "not satisfied" at all to "very satisfied."
Finally, participants are asked to choose the three most important items related to the assistive device in question.

Number of Items

5-30 minutes

Required Training

No Training

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team; Updated with references from the TBI population by Sue Saliga, PT, DHSc, CEEAA and the TBI EDGE task force of the Neurology Section of the APTA in 2012.

ICF Domain

Environment

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
TBI EDGE	No	No	No	Not reported

Considerations

The assessment can be either self-administered or administered by a clinician.

Translations available include:

English
French
Dutch
Norwegian
Portuguese
Japanese
Chinese (2 versions, C-QUEST and T-QUEST)

Experimental version consisted of 24 items, item analysis (Demers et al. 2000) resulted in 12-item scale, the QUEST 2.0

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Normative Data

Multiple Sclerosis: (Demers et al, 2002; QUEST 2.0; n = 83; mean age = 47.8 (9.4) years, types of devices used: Manual wheelchair = 47%, Powered wheelchair = 20%, Scooter = 14%, Regular walker = 12%, Wheeled walker = 7%, English and French speaking sample)

Quest 2.0 Norms with MS Patients:
Dimension	n	Mean (SD)	Min-Max Score
Device	81	4.17 (0.62)	2.13 ±5.00
Service	75	3.98 (0.75)	2.25 ±5.00

Normative Data

SCI patients who use manual wheelchair: (Bergstrom & Samuelsson, 2006; n = 124; mean age = 49.7 (15.6) years; SCI characteristics not reported)

Average (Standard Deviation) score = 3.99 (1.0)
Ease of adjustment (mean = 3.80, SD = 1.1) and comfort (mean = 3.77, SD = 1.0) were rated as least satisfying
Ease of use was rated most satisfying (mean = 4.42, SD = 0.7)

Manual wheelchair user Satisfaction:
Question	% Responding "somewhat satisfied" or less	% Responding "quite satisfied" or "very satisfied"	Mean (SD)
Service delivery	38	62	3.74 (1.2)
Repair service	28	72	3.97 (1.2)
Professional service	26	74	3.90 (1.1)
Follow-up	45	55	3.43 (1.2)

Construct Validity

Chronic SCI: (Chan & Chan, 2007; n = 31; mean age = 41.68 (11.17) years; mean time since injury = 3.79 (3.72) years; ASIA Classification, A = 70.99%, B = 9.68%, C = 3.23%, D = 16.13%, Chinese Sample)

QUEST (Chinese translation, C-QUEST) and WHO QoL-BREF scores:
	QUEST	WHO QoL BREF
	Services	General	Physical	Psychological	Social Relationship	Environment
Device	0.416*	0.412*	0.508*	0.344	0.460*	0.567*
Services	--	0.120	0.307	0.023	0.242	0.333
WHO QoL-BREF
General	--	--	0.352	0.375*	0.032	0.293
Physical	--	--	--	0.482*	0.452*	0.692*
Psychological	--	--	--	--	0.548*	0.577**
Social Relationship	--	--	--	--	--	0.509**
p < 0.05; *p < 0.01

Assistive Technology Users (Demers et al, 2000; n=150)

Assistive Device Users (Wessels et al, 2003; n=2002; mean age=58.0(15.7); gender=female 60.7%-Dutch Version (D-QUEST))· Factor analysis results suggested a bidimensional structure of satisfaction with assistive technology related to the assistive technology device (eight items) and services (four items)

Type of assistive Device	Assistive Device: correlation mean satisfaction 8 aspects and general satisfaction (Spearman’s rho)	Service: Correlation mean satisfaction and general satisfaction (Spearman’s rho)
Aids for personal care	0.77*	0.74*
Orthoses/Shoe adpatations	0.82*	0.79*
Hearing Aids	0.79*	0.81*
Optical Aids	0.68*	0.74*
Aids for diabetics	0.68*	0.71*
Home Furnishings	0.72*	0.87*
Elastic compression stockings	0.75*	0.78*
Prostheses	0.82*	0.84*
Aids for communication and information	0.79*	0.88*
Aids for personal mobility	0.75*	0.83*
Total	0.78*	0.81*

*Excellent validity for all items; *Correlation is significant at the 0.000 level (2-tailed)

Normative Data

Wheelchair users across residential settings: (Karmarkar et al, 2009; n = 132; mean ages ranged from 63.23 (5.6) to 83.8 (5.4) years)

Satisfaction with manual wheelchairs across settings:
QUEST composite scores	VA NH (n = 48)	Private NH (n = 25)	Community dwelling (n = 27)	p
Device Total	3.9 (0.15)	2.9 (0.28)	4.3 (0.25)	0.009*
Services Total	3.6 (0.18)	2.8 (0.38)	4.4 (0.29)	0.020
QUEST total	3.9 (0.15)	2.9 (0.30)	4.3 (0.25)	0.006
VA NH = Veteran's Administration Nursing Home Private NH = Private Nursing Home

Test/Retest Reliability

Community Dwelling Assistive Devise Users: (Mao et al, 2010; (alpha = 105; ICC = 36); mean age = 38.9 to 33.5 years; mean time using device ranged from 2.6 to 3.3 years, The T-QUEST (Taiwanese version) has one additional item, Cost)

T-QUEST Cronbach's alpha and ICC's:
Domain	Items	Strength	Alpha	Strength	ICC
Device	Device Dimension Weight Adjustments Safety Durability Easy to use Comfort Effectiveness	Excellent	0.87	Excellent	0.97
Services	Service delivery Repairs/maintenance Professional services Follow-up services Cost*	Excellent	0.84	Excellent	0.97
Total		Excellent	0.90	Excellent	0.95
* The Cost item is specific to the T-QUEST

Assistive Technology Users-Diagnosis unknown (Demers et al, 2000; n=85; 7-11 days in between testing)

Items with the highest item-total correlations were follow-up services (Weighted Kappa=0.64), simplicity of use (0.63 ), effectiveness (0.63),and adjustments (0.67 )
The lowest item-total correlation was for cost (0.17 )

Item	Test Retest Reliability P<0.01
Comfort	0.51	Adequate
Dimensions	0.74	Adequate
Professional Service	0.61	Adequate
Follow-Up Services	0.56	Adequate
Simplicity of Use	0.52	Adequate
Effectiveness	0.62	Adequate
Repairs/Servicing	0.51	Adequate
Durability	0.69	Adequate
Adjustments	0.52	Adequate
Safety	0.58	Adequate
Service Delivery	0.61	Adequate
Weight	0.63	Adequate
Multi-Purposefulness	0.58	Adequate
Transportation	0.42	Adequate
Maintenance	0.42	Adequate
Training	0.62	Adequate
Device compatibility	0.61	Adequate
Appearance	0.48	Adequate
Installation	0.49	Adequate
Cost	0.55	Adequate
Effort	--	---
Motivation	--	---
Reaction of Others	--	---
Social Circle Support	--	---

Interrater/Intrarater Reliability

Mobility Devise Users: (Demers et al, 1999; n = 97)

Excellent: Device subscale = 0.80
Adequate: Services subscale = 0.76
Excellent: Total scale alpha = 0.82

Internal Consistency

Assistive Device Users (Demers et al, 2000; n=150; Diagnosis unknown))

Items with the highest item-total correlations were follow-up services (r=0.64), simplicity of use (r= 0.63 ), effectiveness (r= 0.63),and adjustments (r=0.67 )
The lowest item-total correlation was for cost (r=0.17 )

Assistive Device Users (Wessels et al, 2003; n=2002; mean age=58.0(15.7); gender=female 60.7%-Dutch Version (D-QUEST))

Type of assistive Device	Device Related Aspects		Service Related Aspects
	N	Alpha	N	Alpha
Aids for personal care	90	0.89 Excellent	51	0.82 Excellent
Orthoses/Shoe adpatations	87	0.90 Excellent	148	0.84 Excellent
Hearing Aids	110	0.85 Excellent	178	0.82 Excellent
Optical Aids	26	0.85 Excellent	34	0.78 Excellent
Aids for diabetics	68	0.82 Excellent	94	0.81 Excellent
Home Furnishings	41	0.88 Excellent	44	0.85 Excellent
Elastic compression stockings	34	0.68 Poor	41	0.73 Adequate
Prostheses	74	0.89 Excellent	126	0.83 Excellent
Aids for communication and information	18	0.92 Excellent	46	0.82 Excellent
Aids for personal mobility	112	0.84 Excellent	49	0.77 Adequate
Total	660	0.88 Excellent	811	0.84 Excellent

Content Validity

Initial items were assessed by a team of 11 individuals who represented both consumers and stakeholders of assistive technologies (Demers, et al. 1996)

Assessed by 12 content experts from 11 facilities in the United States, Canada and the Netherlands and 150 device users (no information on diagnosis) (Demers et al, 2000)

Only two items were very weakly rated by a substantial proportion of content experts, namely installation (#19; 38%) and reaction of others (#23; 31%); the largest proportion of items (n = 18, 75%) was considered of primary importance by more than half the respondents
From the users' point of view, analyses revealed that 19 of the 24 items generated a mean importance score above 4.00 (based on a 5 point rating scale, 1-no importance; 5-very important); based on this cutoff, the items weakly rated were training, appearance, cost, reaction of others, and social circle support

Face Validity

The measure was developed with the assistance of subject matter experts including users of assistive technologies.

Bibliography

Bergstrom, A. L. and Samuelsson, K. (2006). "Evaluation of manual wheelchairs by individuals with spinal cord injuries." Disabil Rehabil Assist Technol 1(3): 175-182. Find it on PubMed

Chan, S. C. and Chan, A. P. (2007). "User satisfaction, community participation and quality of life among Chinese wheelchair users with spinal cord injury: a preliminary study." Occup Ther Int 14(3): 123-143. Find it on PubMed

Demers, L., Ska, B., et al. (1999). "Stability and reproducibility of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)." Journal of Rehabilitation Outcomes Measurement 3(4): 42-52.

Demers, L., Weiss-Lambrou, R., et al. (1996). "Development of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)." Assist Technol 8(1): 3-13. Find it on PubMed

Demers, L., Weiss-Lambrou, R., et al. (2000). "Item analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)." Assist Technol 12(2): 96-105. Find it on PubMed

Karmarkar, A. M., Collins, D. M., et al. (2009). "Satisfaction related to wheelchair use in older adults in both nursing homes and community dwelling." Disabil Rehabil Assist Technol 4(5): 337-343. Find it on PubMed

Mao, H. F., Chen, W. Y., et al. (2010). "Cross-cultural adaptation and validation of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0): the development of the Taiwanese version." Clin Rehabil 24(5): 412-421. Find it on PubMed

Wessels, R. and Witte, L. P. D. (2003). "Reliability and validity of the Dutch version of QUEST 2.0 with users of various types of assistive devices." Disability & Rehabilitation 25(6): 267-272.

Purpose

Link to Instrument

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Normative Data

Normative Data

Construct Validity

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Internal Consistency

Content Validity

Face Validity

Bibliography

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