Keywords

1 Introduction

Arm support is an assistive technology device (ATDs) that has been used since the 1960s to supplement the performance of activities of daily living (ADLs) of those who (e.g., Spinal cord injury, Muscular dystrophy, Multiple sclerosis) limited upper extremity muscle strength [1]. It provides stability to the proximal part of the shoulder by removing gravity acting on the upper limb through an armrest and assists shoulder and elbow movement through a power source [2]. In recent, the power source of arm support is developing with the development of technology. Because of this, people with disabilities who use arm support can receive support for a wider range of movements. According to a systematic review by Lee et al. (2021), the proportion of arm supports was the highest among the upper extremity ATDs to assist people with disabilities in their ADLs [3]. Also, they found that the power source for assisting the user’s movement is changing from a spring to an actuator, electricity to assist the user’s active movement according to the development of technology. Changes in power sources will affect how users manipulate arm support and the extent to which it can assist a user’s functional movements [4]. Therefore, in the clinical field, it is required to set up an assessment system that can prescribe appropriate arm support according to the function of the people with disabilities and measure the effectiveness after the intervention. Standardized assessment about ATDs relies on the subjective judgment of the user, such as satisfaction and psychosocial impact [5, 6]. In addition, objective assessment systems and methods for performance are limited. This is a critical barrier to assessing the multifaceted effectiveness of ATDs. Therefore, the purpose of this study is to collect and systematically analyze studies that have been assessed about arm support, and to suggest directions for establishing an assessment system.

2 Method

2.1 Database and Search Term

This study searched for studies that applied arm support as an intervention in 4 literature search databases (Embase, CINAHL Plus with Full text, Web of science, and Scopus). Search terms were “Arm support” AND (Assessment OR Evaluation OR Measurement) and search period was set to the past 10 years.

2.2 Selection Strategy

The studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement [7].

Studies were included if they met the following criteria: (1) studies on people with disabilities, (2) studies that assessed after providing arm support as an intervention, (3) can see the full text, (4) studies written in English or Korean. And, studies were excluded if they met the following criteria: (1) studies that not provided arm support as an intervention, (2) studies about reliability and validity of assessment tool, (3) studies on people without disabilities, (4) Systematic review & meta-analysis, (5) Grey literature, (6) Studies that could not open the full text.

Literature selection was carried out by two researchers. In case of disagreement between the researchers, it was discussed and agreed upon. Consequently, 19 studies were selected for this study (Fig. 1).

Fig. 1.
figure 1

PRISMA flow chart

Full size image

2.3 Analysis

The selected articles were analyzed frequency for the type of disability, assessment area, assessment method, frequency of assessment tools by area, and measurement method of assessment tools.

3 Result

3.1 Type of Disability

In terms of the type of disability, most of the studies have been conducted on people who have decreased performance in daily activities mainly due to decreased muscle strength in the shoulders and elbows. Sixteen studies were conducted on people with muscular dystrophy which is a loss of strength from the proximal to the distal part of the shoulder. It is occupied the largest proportion. Eight studies were conducted on people with spinal muscular atrophy. And three studies were conducted on people with spinal cord injury, stroke, and arthrogryposis, respectively (Table 1).

Table 1. Type of disabilities on subjects
Full size table

3.2 Assessment Area

In the included studies, Upper extremity performance and function were primarily assessed about arm support interventions. This is consistent with the results of previous research [3]. It can be confirmed that it is an important factor to measure the function and ADL performance in the assessment of arm support intervention. In addition, it was found that assessment was performed through the subjective judgment on usability, satisfaction, psychosocial influence, fatigue, and workload according to the use of the arm support (Table 2).

Table 2. Assessment area included studies
Full size table

3.3 Assessment Method

The included studies used either quantitative or qualitative method to assess the effect of arm support on the area. Most studies used standardized assessment tool to measure effectiveness of arm support. By using a standardized assessment tool, it is possible to secure the validity and reliability of the results. Kinematics through 3D motion analysis was used to measure performance and function based on tasks (e.g., Workspace, Range of motion). Physical examination which is the traditional method of measuring function mainly assessed range of motion (ROM) with a goniometer and manual muscle strength (MMT). Through qualitative methods such as questionnaires and observations, factors that are difficult to measure quantitatively were assessed (Table 3).

Table 3. Assessment Method included studies
Full size table

3.4 Assessment Tool by Area

Looking at the assessment tools by area, tools for measuring performance and function occupied about 80% of the total. Since there is no assessment tool centered on assistive technology, the occupational therapy assessment tool was used or modified for assess on performance and function. There were two assistive technology-focused assessment tools: QUEST which measures satisfaction with the device and service process, and PIADS which measures the psychosocial impact of using assistive technology (Table 4).

Table 4. Assessment tool by area included studies
Full size table

3.5 Measurement Method of Assessment Tool

Most assessments measure effectiveness through the performance of tasks related to ADL, which are mostly utilized to measure performance and function. A questionnaire-based assessment tool is used to investigate users’ subjective feelings about the effectiveness of arm support. There were also studies that used semi-structured interview and observation to measure the effectiveness of the arm support (Table 5).

Table 5. Measurement method of assessment tool included studies
Full size table

4 Conclusion

Arm support is an assistive device that compensates for shoulder and elbow movements to help those with reduced upper extremity muscle strength perform activities ADLs. Due to the development of technology, the assisting method and range, and operation method of arm support are also changing. Accordingly, a system for properly matching and assessing effects in consideration of the user’s function, environment, and activity is required in the clinical field. In this study, we examined assessment trends and suggest an appropriate direction for assessment by systematic review on studies that measured the effectiveness of arm support. First, the assessment area for arm support is mainly focused on performance and function. The use of assistive devices interacts not only with the user but also with the activity and environment. Therefore, a comprehensive assessment considering not only users but also activities and environments should be conducted. Second, assessment tools are the most popular way to measure the effectiveness of arm support. However, when looking at the trend of tools by assessment area, the assessment tools centered on assistive technology are extremely limited. The majority of studies use modifications of existing occupational therapy assessments to measure performance and function. It is necessary to develop an assistive technology-centered performance assessment tool or method. Third, the effectiveness of arm support is measured through task-based performance. Assigned tasks are mainly composed of ADLs and instrumental activities of daily living (IADLs). Therefore, it is required to establish an environment for measuring effects based on ADLs and IADLs related to using arm support. We expect this to be useful in the process of measuring the effect after providing arm support as an intervention for those who have decreased performance in daily activities mainly due to decreased muscle strength in the shoulders and elbows.