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VOLUME 7, ISSUE 1 

 2024 
 

RESEARCH ARTICLE 

 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. 

Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

 

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https://doi.org/10.33137/cpoj.v7i1.43790


 

1 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

 

 

RESEARCH ARTICLE 

 

EXPLORING FACTORS FOR PRESCRIPTION AND VALIDATION OF ACTUATED UPPER 

LIMB DEVICES: A CROSS-SECTIONAL SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, Buis A*  

Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland. 
 
  
 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

Upper limb impairment can affect anyone at any time. Age, 

injury, disease, and other conditions may present a person 

with motor impairments such as weakness, paralysis, 

spasticity, tremors and dystonia. They may have a full 

recovery to independent life through rehabilitation, but 

others may require further support. When upper limb motor 

impairments affect the hands and wrist, which is the focus 

of this study, activities of daily living (ADLs) are negatively 

impacted. Functional tasks such as self-care, cooking, and 

working  may  be  affected  which  can  reduce  community  

 

 

 

engagement and quality of life.1,2 In addition, a person may 

require regular support from caretakers and allied health 

professionals, these visits and other expenses present 

financial, resource and time burdens on the medical 

sector.3-6  

Assistive devices can be prescribed to support persons who 

require additional functionality and prehension in their upper 

limbs. Assistive devices have a history of use in medical and 

occupational fields.7,8 They can range from orthotics to 

complex machinery such as an exoskeleton. Orthotic 

devices such as splints and braces are used to stabilise and 

support the limb which aids in maintaining proper alignment 

and preventing further injury. Orthotic devices can be 

custom-made or prefabricated. Exoskeletons are robotic 

assistive devices which support and enhance movements, 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: Actuated devices can be beneficial for individuals with upper limb muscle weakness, 

offering extra force and grip. Utilising this type of assistive device can facilitate daily activities, thereby 

enhancing independence and overall quality of life. The development of actuated assistive devices has 

been growing, and current literature shows promise in their clinical use. However, they are not yet 

medically recommended by global guidelines and councils. Studies have suggested why assistive devices 

have barriers to access, but actuated devices have not been a focus in these discussions.  

OBJECTIVE(S): To address this issue, a survey was conducted among professionals who prescribe and 

assess upper limb assistive devices. The survey aimed to gather their opinions and quantify the factors 

that might contribute to the limited use of actuated devices in the field. 

METHODOLOGY: A web-based cross-sectional study was designed using Qualtrics, contained 25 items 

and was conducted between October 2023 and January 2024. The survey was piloted, validated, and 

ethically approved. Results were statistically analysed, and open questions underwent thematic analysis.  

FINDINGS: 87 Allied Health Professionals (AHPs) contributed to the survey, with a completion rate of 69% 

(60/87). Survey respondents predominately worked from the USA (72%). The survey revealed that 66% 

of respondents felt they did not have sufficient access to assistive devices and 58% indicated that outcome 

measures could be improved. They also noted that actuated devices needed to better meet user-centric 

needs. Barriers to prescribing these devices included a lack of awareness, experience and standardised 

prescription methods. In addition, the limited time with patients made decision-making and validation of 

an actuated device difficult.  

CONCLUSION: AHP’s have experience prescribing assistive devices but do not have access, knowledge, 

or clinical methods to assess the use of actuated devices. Future designs for actuated devices should 

focus on wearability, comfort, user satisfaction, safety and ease of use. 

ARTICLE INFO 

Received: July 30, 2024 

Accepted: September 13, 2024 

Published: September 22, 2024 
 

CITATION 

Galbert A, Buis A. Exploring factors 

for prescription and validation of 

actuated upper limb devices: A 

cross-sectional survey of allied 

health professionals. Canadian 

Prosthetics & Orthotics Journal. 

2024; Volume 7, Issue 1, No.4. 

https://doi.org/10.33137/cpoj.v7i1.4

3790 

KEYWORDS 

Assistive Device, Exoskeletons, 

Actuated, Powered, Allied Health 

Professionals, Upper Limb, Design, 

Outcome Measures, Orthosis, 

Rehabilitation, Satisfaction, Survey 

 

* CORRESPONDING AUTHOR: 

Professor Arjan Buis, PhD 

Department of Biomedical Engineering, Faculty of Engineering, University 
of Strathclyde, Glasgow, Scotland. 

E-Mail: arjan.buis@strath.ac.uk 

ORCID ID: https://orcid.org/0000-0003-3947-293X 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 7, Issue 1, Article No.4. 2024 

 

 

https://doi.org/10.33137/cpoj.v7i1.43790
https://doi.org/10.33137/cpoj.v7i1.43790
https://doi.org/10.33137/cpoj.v7i1.43790
mailto:arjan.buis@strath.ac.uk
https://orcid.org/0000-0003-3947-293X
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

they have been used in rehabilitation clinics to aid in 

restoring motor function. Other assistive devices can 

include adaptive equipment, arm supports, and mechanical 

hand and finger exercisers to improve grip through 

repetitive exercises. The level of support and type of tools 

should reflect the user’s needs. Therefore, an actuated, 

powered, and active device would be appropriate for users 

needing additional strength during everyday tasks. These 

devices provide additional force using motors to attain the 

power requirements for ADLs. Yet, these devices are not 

listed as recommended tools in guidelines such as the NICE 

guidelines.9 Current literature on assistive technology in 

global and low- and middle-income countries has reported 

barriers such as cost, weight, validation, and poor market 

conditions.10,11 However, actuated and powered devices for 

the upper limb have not been specifically highlighted in 

these reports. Due to the recent emergence of actuated 

assistive devices and the rapid pace of ongoing research, 

there is a lack of longitudinal studies validating their clinical 

efficacy.12  

To explore why actuated assistive devices for hand motor 

impairments are not recommended, a cross-sectional 

survey was conducted to gather opinions from stakeholders 

who assess and prescribe assistive devices. Stakeholder 

opinion on assistive technology has been conducted 

previously but focused on service providers,13 training 

needs,14,15 and software applications.16 In addition, literature 

that has focused on the design and application of assistive 

devices for upper limb impairment lacked a stakeholder 

perspective.17 These stakeholders, who support and 

understand user needs, can provide valuable insights into 

design factors and outcome measures, aiding in the 

development and clinical validation of future actuated 

devices.  

A cross-sectional survey is a time-efficient and cost-

effective method for summarizing the population’s 

relationship to certain characteristics, behaviors, or 

outcomes. It is an observational study that collects data 

from a population (in this case, allied health professionals) 

at a single point in time to assess the prevalence of various 

outcomes. For this study, the focus is on gathering the 

population’s opinions on assistive device design and 

validation methods. Cross-sectional studies can be 

conducted through interviews and surveys, a survey was 

chosen for its efficiency and accessibility. 

The study aims to conduct a cross-sectional survey to 

explore barriers and limitations of actuated assistive 

devices with a 2-part focus on trends in current assistive 

devices and recommended outcome measures. The 

objectives include quantifying important design factors, and 

investigating trends in assistive devices and outcome 

measures used for persons with motor impairment in the 

upper limb.  This will contribute to the field of actuated 

assistive devices and provide a basis for future research in 

new designs and validation processes to improve 

prescription. 

METHODOLOGY 

Recruitment 

An online cross-sectional survey was designed and 

conducted from October 2023 to January 2024 in Qualtrics, 

a web-based software for creating surveys. The research 

was approved by the University of Strathclyde's 

Departmental Ethical Committee (DEC.BioMed.2023.348). 

The participation information sheet and consent forms were 

integrated into the survey questions (found in the 

Appendix). All collected data was anonymized, and data 

protection and risk assessment protocols were followed.  

Inclusions for participation in the study were limited to those 

who currently work, or have worked, in the field of upper 

limb assistive devices, individuals with first or second-hand 

experience with users requiring assistive devices, who 

understand English for academic discussion, and those with 

access to a device capable of completing the online survey. 

Individuals who have not practised in this field within the last 

5 years were excluded.  

Four associations in the appropriate fields of the study were 

contacted for dissemination of the survey. These included 

the American Society of Hand Therapists (ASHT), the 

British Association of Hand Therapists (BAHT), the British 

Association of Prosthetics and Orthotics (BAPO), and the 

International Society of Prosthetics and Orthotics (ISPO). 

As part of the approval for dissemination, each association 

included a validation and piloting process. 

ASHT required ethical approval, and the survey was 

reviewed with feedback from 2 members of the research 

division. BAHT reviewed the survey with feedback from 2 

clinical evidence committee members using the Harvard 

University Program on Survey Research (PSR) 

questionnaire.18 BAPO required ethical approval and pilot-

tested the survey with 9 members of their research 

committee. ISPO also required ethical approval. The survey 

was internally validated using the Checklist for Reporting 

Results of Internet E-Surveys (CHERRIES) by Eysenbach19 

and followed Siny Tsang guidelines for developing, 

translating, and validating a questionnaire.20  

Once the survey had been approved, the associations 

disseminated the survey link via posters, newsletters, and 

mailing lists. We also used social media platforms and 

conferences to advertise the study. No incentives were 

provided to fill out the online survey.  

Survey design 

The survey was designed in a structured format comprising 

25 items which can be found in the Appendix: 4 Open 

questions, 10 Closed questions, 10 Multiple choices, and 1 

https://doi.org/10.33137/cpoj.v7i1.43790
https://asht.org/
https://www.hand-therapy.co.uk/
https://www.bapo.com/
https://www.bapo.com/
https://www.ispoint.org/


 

3 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Likert scale. It starts with the participant information sheet, 

followed by the consent form. The survey then consisted of 

4 main sections focusing on AHPs' perspectives on 

assistive devices and a second part on the rationale for the 

lack of prescription. 

Demographics 

This section included questions related to participants’ 

occupations, experience in the field (in years), country of 

work, and the patient population they interact with. Allied 

health professionals may have multiple roles, therefore, 

occupation selection allows for multiple choice.  

Actuated devices 

Participants were asked if they prescribed and or assessed 

assistive devices for hands and wrists, this was required for 

adaptive questions further on in the survey. They were then 

asked if they recognised and had experience with the 

assistive devices listed compiled from current literature21 

and discussions with clinicians who did not pilot the survey. 

The list was designed to include a range of devices from 

static casts to robotic actuated devices. The inclusion of 

non-actuated devices in the list was important to reduce 

response bias.  

Those who did not prescribe or assess assistive devices 

had the opportunity to give their perspectives on why they 

do not. This section also asked for opinions on access to 

devices and how they are financed. 

Design factors 

Design factors were based on a modified Quebec User 

Evaluation of Satisfaction with Assistive Technology 

(QUEST 2.0).22 Additional modifications included the 

removal of “access” for “service” items, changes to the 

ranking labels from “satisfaction” levels to “level of 

importance”, and item labels were adjusted to better suit 

actuated devices such as adding mechanical power. 

Participants would be asked for their opinions and 

experiences on assistive devices, these open-question 

responses would undergo thematic analysis to extract 

additional design factors missed by the QUEST 2.0. 

Outcome measures  

This section asked participants if they have experience 

using outcome measures and let them pick which they had 

used and recommend from a list made from results of a 

dataset21 and literature.23 Respondents were then asked to 

identify the main limitations to assessing outcomes for 

patients and if they believed outcome measures were useful 

and could be improved.  

Validity, Bias, and Limitations 

The validity of the survey was assessed by correspondents, 

ASHT and BAHT committee members, using respected 

guidelines and questionnaires. These included the PSR 

questionnaire,18 CHERRIES19 and subjective judgement 

from persons in the relevant fields. Due to time constraints, 

test-retest reliability was not conducted. To reduce the 

effect of this limitation, time limits were removed, and the 

questionnaire was designed to take less than 15 minutes.24 

Estimated time found using the Qualtrics predicted duration 

programme. The absence of a time limit can aid in higher 

completion rates as respondents can complete the survey 

at their own pace.25   

Coverage bias was expected due to requiring English 

speakers and an internet connection. In addition, although 

the survey was disseminated across four different 

associations via a mailing list, members may have 

unsubscribed. Coverage bias could not be avoided but was 

mitigated as best as possible.  

To mitigate sampling bias, the target population and 

sampling frame were clearly defined within the inclusion 

criteria. Non-response and measurement errors were 

reduced by circulating the survey, varying question styles, 

and allowing neutral responses to questions.  

Data analysis 

The demographic features of participants were analysed, 

and participants were grouped by discipline. Interactions 

between nominal data were summarized to determine 

significant trends. Multiple-choice questions were analysed 

using cross-tabulation. These quantitative analyses were 

performed using Microsoft Excel (version 2408) and Python 

(3.12) in Visual Studio.  

Open-ended questions were coded using thematic analysis 

following Braun and Clarke's methods.26 The process 

followed an inductive approach in which the data 

determined the themes. As the open questions were not 

required, the response rate tended to be lower therefore 

latent deduction aided in theming the subtext and 

assumptions underlying the data. Each open question was 

analysed separately. Themes were then compared across 

relevant sections to provide qualitative evidence. The 

thematic analyses were performed by hand on Microsoft 

Excel. 

RESULTS 

Participants 

87 unique responses were collected, with a 69% (60/87) 

completion rate. All analyses are on the 60 fully completed 

responses, participant demographic features are present in 

Table 1. Years of experience in the field ranged from 3 

months to 52 years (mean=24.42, SD=13.68). AHPs may 

have multiple job roles, therefore when asking for 

occupation, participants could choose multiple options 

leading to 105 total responses from the 60 participants 

including Occupational Therapists (OT) (44%, 46/105), 

https://doi.org/10.33137/cpoj.v7i1.43790


 

4 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Hand Therapists (HT) (39%, 41/105), Orthotist (10%, 

11/105), Prosthetist (3%, 3/105), Health Care Assistant 

(HCA) (1%, 1/105), Physiotherapist (1%, 1/105), 

Rehabilitation Specialist (1%, 1/105), and unspecified other 

(1%, 1/105). 

The respondents interacted with a range of patient 

populations, as presented in Table 1. The top prevalent 

patient conditions included Carpal Tunnel Syndrome (87%, 

52/60), Epicondylitis (80%, 48/60), Peripheral Neuropathy 

(77%, 46/60), Stroke (47%, 28/60) and Parkinson's Disease 

(37%, 22/60). Muscle weakness tends to be a symptom in 

these conditions, but pain is also a major factor when 

deciding on treatment and management of conditions. 

Current practices may recommend splinting and bracing for 

the affected upper limb. This approach is well-researched 

for the patient conditions supported by the respondents.  

The respondents primarily worked from the USA (72%, 

43/60), followed by the UK (18%, 11/60); Switzerland, South 

Africa, Nigeria, and Ireland each had 1 survey taker, and 2 

participants did not respond to this question. A noticeable 

USA-centric participation group influenced the results, 

particularly when respondents were asked about the 

funding mechanisms for assistive devices. Multiple funding 

sources can be used within a medical department, so 

respondents were given the option to select all applicable 

sources, resulting in 80 responses. Private health insurance 

was the most prevalent funding source, cited by 43% 

(34/80) of respondents, followed by self-funded options at 

34% (27/80). This distribution reflects the structure of the 

U.S. medical sector, where a universal healthcare system is 

not in place.  

Assistive devices 

Many of the assistive devices recognised in Table 2 used 

electrical stimulation (70%, 42/60); The TENS Stimulator 

(65%, 39/60) was the most recognised assistive device, and 

respondents also had the most experience using it (45%, 

27/60). In comparison, AHPs did not have experience using 

powered and actuated devices (15%, 9/60). MyoPro 

Orthosis was the most recognised and used actuated 

device. The MyoPro is an American device which uses 

Electromyography (EMG) to trigger upper limb movement. 

The discrepancies in Table 2 may be due to response errors 

when completing the survey. 

13 respondents did not recognize any of the listed devices. 

However, 62% of these respondents (8/13) indicated that 

they prescribe assistive devices. This suggests that the 

curated list of assistive devices did not capture their 

experiences. 

Many AHPs responded negatively (50%, 30/60) or were 

unsure (17%, 10/60) when asked if they had enough access 

to assistive devices. Surprisingly, only 6 people felt they 

“definitely” had enough access to assistive devices.  

Nine participants work in workplaces that do not offer 

assistive devices. All of them are based in the USA (100%, 

9/9) and support patients with carpal tunnel syndrome 

(100%, 9/9) and epicondylitis (100%, 9/9). The majority are 

occupational therapists (89%, 8/9). Reasons why assistive 

devices are not offered by this group were extracted from 

their open-ended responses and analyzed using thematic 

analysis. From the nine responses, five themes emerged: 

(1) AHPs’ belief that the patient population is not appropriate 

for devices, (2) the patient population is not large enough, 

(3) AHPs lack exposure to assistive devices, (4) a lack of 

availability of devices, and (5) the cost of the devices. 

“Not enough clients coming that need them [assistive 

devices] on a regular basis.  If we had a sporadic client 

needing one, we would research and try to reach out for 

options” (OT, USA, 32) (Occupation, country, experience in years) 

Although this group of respondents did not routinely offer 

assistive devices in their workplace, the reasons mentioned 

above overlap with the thematic analysis of the opinions and 

experiences other AHPs had with assistive devices shown 

in Table 3. 

Both thematic analysis (Table 3) and the Likert responses 

(Figure 1) showed similar factors which affect the 

prescription of actuated devices. AHPs had concerns about 

devices’ designs not being multifunctional and 

uncomfortable for users. User-centric factors (as opposed 

to mechanical factors) such as comfort, satisfaction, safety 

and ease of use have a strong level of importance across 

all demographics. Yet if the device is too heavy or not 

versatile enough, the users may adapt to not needing one. 

When comparing the devices used (Table 2) with the factors 

shown in Figure 1, the right balance of these factors is 

difficult to determine. For instance, weight is considered 

less important than comfort but ensuring a device’s weight 

and weight distribution is minimalized is often a physical 

attribute to determine comfort. 

Outcome measures 

Figure 1 quantifies well-established factors of importance 

pertaining to design, while Table 3 captures themes often 

forgotten. In Table 3, AHPs felt that there were unclear 

prescription methods and a lack of awareness of these 

devices. To better understand prescription methods, the 

latter half of the survey focused on outcome measures. 

When and which types of outcome measures are used are 

essential for tracking improvements in users’ functionality 

and validating assistive devices. 71% (43/60) of AHPs had 

experience using outcome measures for upper limb 

assessment, while 12% (7/60) had some experience and 

17% (10/60) had no experience. Most respondents (72%, 

43/60) found outcome measurement tools useful while the 

remainder were unsure (17/60). 

 

https://doi.org/10.33137/cpoj.v7i1.43790


 

5 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Table 1: List of Participants. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ID No. Occupation(s) 
Work 
experience 
(Years) 

Country of work Patient population(s) interacted with 

Assessor 
of 
assistive 
device? 

PRESCRIBERS OF ASSISTIVE DEVICES (Rows 1 to 46) 

1 
Hand Therapist, 
Occupational Therapist 

13 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Multiple sclerosis, 
Parkinson's disease, Peripheral neuropathy, Stroke 

Yes 

2 Orthotist 25 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Multiple sclerosis, Parkinson's disease, Peripheral 
neuropathy, Spinal Cord Injury, Stroke 

Yes 

3 
Hand Therapist, 
Occupational Therapist 

38 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Stroke 

Yes 

4 Orthotist 7 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Multiple sclerosis, Parkinson's disease, Peripheral 
neuropathy, Spinal Cord Injury, Stroke 

Yes 

5 Orthotist 4.5 
United Kingdom of 
Great Britain and 
Northern Ireland 

Cerebral palsy, Duchenne muscular dystrophy, Multiple sclerosis, 
Parkinson's disease, Peripheral neuropathy, Spinal Cord Injury, 
Stroke, Diabetes*, Paediatrics* 

Yes 

6 Occupational Therapist 30 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Stroke Yes 

7 
Hand Therapist, 
Occupational Therapist 

40 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Stroke, Trauma Injury* 

Yes 

8 
Hand Therapist, 
Occupational Therapist 

20 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy Yes 

9 Hand Therapist 42 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Multiple sclerosis, 
Parkinson's disease, Peripheral neuropathy, Trauma Injury*, 
Amputation*, Laceration Repair*, General 

Yes 

10 Orthotist 0.25 
United Kingdom of 
Great Britain and 
Northern Ireland 

Cerebral palsy, Multiple sclerosis, Parkinson's disease, 
Peripheral neuropathy, Spinal Cord Injury, Stroke 

Yes 

11 
Hand Therapist, 
Occupational Therapist 

20 
United States of 
America 

Carpal tunnel syndrome, Cerebral palsy, Epicondylitis, Multiple 
sclerosis, Parkinson's disease, Peripheral neuropathy, Stroke 

Yes 

12 Hand Therapist 38 Switzerland Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy Yes 

13 
Hand Therapist, 
Occupational Therapist 

28 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Trauma Injury*, Arthritis, 
General 

Yes 

14 
Hand Therapist, 
Occupational Therapist, 
Other (please specify) 

52 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Parkinson's disease, 
Peripheral neuropathy, Trauma Injury*, Laceration Repair* 

Yes 

15 
Hand Therapist, 
Occupational Therapist 

32 
United States of 
America 

Carpal tunnel syndrome, Cerebral palsy, Epicondylitis, Peripheral 
neuropathy, Stroke 

Yes 

16 
Hand Therapist, 
Occupational Therapist 

15 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Stroke, Amputation*  

Yes 

17 
Hand Therapist, 
Occupational Therapist 

27 
United States of 
America 

Carpal tunnel syndrome, Duchenne muscular dystrophy, 
Epicondylitis, Multiple sclerosis, Peripheral neuropathy, 
Laceration Repairs*, Trauma Injury*, General 

Yes 

18 Occupational Therapist 29 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Trauma Injury* Yes 

19 
Hand Therapist, 
Occupational Therapist 

37 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Stroke 

Yes 

20 Occupational Therapist 39 South Africa 

Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Epicondylitis, Parkinson's disease, Peripheral 
neuropathy, Spinal Cord Injury, Stroke, Trauma Injury*, 
Laceration Repair*, General 

Yes 

21 Occupational Therapist 33 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Parkinson's disease, 
Peripheral neuropathy, Spinal Cord Injury, Stroke, Laceration 
Repairs* 

Yes 

22 
Hand Therapist, 
Occupational Therapist 

33 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Stroke 

Yes 

23 
Hand Therapist, 
Occupational Therapist 

32 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis Yes 

24 
Hand Therapist, 
Occupational Therapist 

28 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Multiple sclerosis, 
Parkinson's disease, Peripheral neuropathy, Spinal Cord Injury 

Yes 

25 Occupational Therapist 23 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Cerebral palsy, Epicondylitis, Multiple 
sclerosis, Parkinson's disease, Peripheral neuropathy, Stroke, 
Trauma Injury* 

Yes 

26 
Hand Therapist, 
Occupational Therapist 

50 
United States of 
America 

Peripheral neuropathy, Spinal Cord Injury, Burns*, Amputation* Yes 

 

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6 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Table 1 (continued): List of Participants. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ID No. Occupation(s) 
Work 
experience 
(Years) 

Country of work Patient population(s) interacted with 

Assessor 
of 
assistive 
device? 

PRESCRIBERS OF ASSISTIVE DEVICES (Rows 1 to 46) 

27 
Hand Therapist, 
Occupational Therapist 

33 
United States of 
America 

Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Epicondylitis, Multiple sclerosis, Parkinson's disease, 
Peripheral neuropathy 

Yes 

28 
Hand Therapist, 
Occupational Therapist 

42 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Laceration Repairs*, General* 

Yes 

29 Occupational Therapist 24 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy Yes 

30 
Hand Therapist, 
Occupational Therapist 

27 
United States of 
America 

Carpal tunnel syndrome, Peripheral neuropathy Yes 

31 
Hand Therapist, 
Occupational Therapist 

9 
United States of 
America 

Carpal tunnel syndrome, Duchenne muscular dystrophy, 
Epicondylitis, Multiple sclerosis, Peripheral neuropathy, Spinal 
Cord Injury, Stroke 

Yes 

32 Occupational Therapist 22 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy Yes 

33 
Hand Therapist, 
Occupational Therapist 

42 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Orthopedics*, Arthritis* 

Yes 

34 
Hand Therapist, 
Occupational Therapist 

6 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Trauma Injury*, Orthopedics* 

Yes 

35 Hand Therapist 24 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy Yes 

36 
Hand Therapist, 
Occupational Therapist 

40 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Parkinson's disease, 
Peripheral neuropathy 

Yes 

37 
Hand Therapist, 
Occupational Therapist 

50 
United States of 
America 

Spinal Cord Injury, Burns*, Amputation*, General* Yes 

38 
Hand Therapist, 
Occupational Therapist 

43 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
General*, Arthritis* 

Yes 

39 Orthotist 11 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Epicondylitis, Multiple sclerosis, Parkinson's disease, 
Peripheral neuropathy, Spinal Cord Injury, Stroke 

Yes 

40 

Hand Therapist, Health 
Care Assistant (HCA), 
Orthotist, Physiotherapist, 
Prosthetist, Rehabilitation 
Specialist 

3 Nigeria Cerebral palsy, Stroke Yes 

41 Orthotist, Prosthetist 29 Ireland 
Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Epicondylitis, Multiple sclerosis, Parkinson's disease, 
Peripheral neuropathy, Spinal Cord Injury, Stroke, Amputation* 

Yes 

42 Orthotist 10 
United Kingdom of 
Great Britain and 
Northern Ireland 

Carpal tunnel syndrome, Cerebral palsy, Duchenne muscular 
dystrophy, Epicondylitis, Multiple sclerosis, Parkinson's disease, 
Peripheral neuropathy, Spinal Cord Injury, Stroke 

Yes 

43 Orthotist 12 
United Kingdom of 
Great Britain and 
Northern Ireland 

Cerebral palsy, Multiple sclerosis, Spinal Cord Injury, Stroke Yes 

44 Orthotist, Prosthetist 6 
United Kingdom of 
Great Britain and 
Northern Ireland 

Cerebral palsy, Spinal Cord Injury, Stroke Yes 

45 
Hand Therapist, 
Occupational Therapist 

6 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Parkinson's disease, 
Peripheral neuropathy 

No 

46 
Hand Therapist, 
Occupational Therapist 

9 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy No 

NON-PRESCRIBERS OF ASSISTIVE DEVICES (ROWS 47 TO 60) 

47 
Hand Therapist, 
Occupational Therapist 

26 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Multiple sclerosis, 
Parkinson's disease, Peripheral neuropathy, Stroke, Laceration 
Repair* 

Yes 

48 
Hand Therapist, 
Occupational Therapist 

32 
United States of 
America 

Carpal tunnel syndrome, Cerebral palsy, Epicondylitis, Multiple 
sclerosis, Parkinson's disease, Peripheral neuropathy, Spinal 
Cord Injury, Stroke 

Yes 

      

      

      

https://doi.org/10.33137/cpoj.v7i1.43790


 

7 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Table 1 (continued): List of Participants. 

Although the majority found them useful, 58% (35/60) 

believed outcome measurement tools could be improved. 

Outcome measures may be used for various reasons. 

Therefore, AHPs were asked to select all applicable options 

for when they use outcome measures. Results showed that 

they are used to assess patients’ needs (44%, 48/108), and 

to evaluate patients during (20%, 22/108) and after (19%, 

20/108) the use of assistive devices. They were often not 

used to evaluate the assistive device (17%, 18/108). Survey 

responses from AHPs regarding upper limb outcome 

measures and tools revealed that many of the measures 

they had used were not recommended, as shown in 

Table 4. The variety of outcome measures recommended 

span from simple observational tasks such as the 9HPT to 

patient-reported outcomes. AHPs often recommended an 

arsenal of outcome measures tests and rarely relied on a 

singular test to capture hand/wrist assessment. 

Alongside knowing which outcome measures are 

recommended, participants expressed the limitations of 

outcome measures. Time constraints are often a limitation 

in the medical sector, and immense pressure is noticed on  

 

healthcare providers27 which is reflected in Table 5. The 

results of the thematic analysis, presented in Table 6, 

highlight poor functionality of outcome measures as a 

recurring theme. Improvements were identified and 

included using handedness, using a bank of ADLs, 

including don and doff features, satisfaction levels, and 

objective tasks as part of the outcome measure. Some of 

the responses in the functionality theme overlap with 

relevance and documentation. Respondents wanted 

outcome measures to be a method of seeing patients 

improve, yet choosing which outcome measures to use was 

an issue.   

The involvement of funding sources affected the use of 

outcome measures for three AHPs in the USA. Some 

funding sources dictate which outcome measures to use, 

while others allow AHPs to choose as quoted in the 

financing theme. When these AHPs were told which 

outcome measures to use by a funding source, such as an 

insurance company, there were negative responses as 

quoted below: 

“Often outcome measurements are dictated by the 

company you work for or the insurance plan - typically these 

are not the most effective measurement tools that we have 

available” (HT/OT, USA, 23) (Occupation, country, experience in years) 

ID No. Occupation(s) 
Work 
experience 
(Years) 

Country of work Patient population(s) interacted with 

Assessor 
of 
assistive 
device? 

NON-PRESCRIBERS OF ASSISTIVE DEVICES (ROWS 47 TO 60) 

49 Occupational Therapist 10 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Orthopedics* Yes 

50 
Hand Therapist, 
Occupational Therapist 

23 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Parkinson's disease, 
Peripheral neuropathy 

Yes 

51 
Hand Therapist, 
Occupational Therapist 

16 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Multiple sclerosis, 
Peripheral neuropathy, Stroke 

Yes 

52 Occupational Therapist 32 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Orthopedics*, Laceration Repair*  

No 

53 
Hand Therapist, 
Occupational Therapist 

13 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy No 

54 
Hand Therapist, 
Occupational Therapist 

28 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, General No 

55 
Hand Therapist, 
Occupational Therapist 

1 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Parkinson's disease, 
Peripheral neuropathy, Stroke 

No 

56 
Hand Therapist, 
Occupational Therapist 

34 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Orthopedics* No 

57 
Hand Therapist, 
Occupational Therapist 

37  Carpal tunnel syndrome, Epicondylitis No 

58 
Hand Therapist, 
Occupational Therapist 

7.5 
United States of 
America 

Carpal tunnel syndrome, Osteoarthritis*, Trauma Injury*, 
Dupuytren* 

No 

59 
Hand Therapist, 
Occupational Therapist 

12 
United States of 
America 

Carpal tunnel syndrome, Epicondylitis, Peripheral neuropathy, 
Stroke 

No 

60 Orthotist 10  Duchenne muscular dystrophy  No 

Note: * Patient Populations abstracted from text response 

 

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8 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

  *(Occupation, country, and experience in years) 

Table 2: Assistive devices recognised and used by respondents including their key features. 

Device Name Type of device Device Feature 

Count of 
assistive 
devices 
recognised (n) 

Count of assistive 
devices AHPs have 
working experience 
using (n) 

TENS Stimulator TENS Passive Electrical Stimulation 39 27 

SaeboMAS Anti-gravity support Clinical Tool 17 8 

None   13 8 

MyoPro Orthosis Powered and actuated device  EMG control 10 5 

EXOTIC exoskeleton Powered and actuated device Rigid exoskeleton 9 1 

ReHand Rehabilitation Software Tablet-based 8 2 

GraspyGlove Powered and actuated device Soft exoskeleton 5 1 

Hand of Hope Powered and actuated device EMG control 5 0 

X-Glove Powered and actuated device Rigid exoskeleton 4 0 

JACO Assistive robotic arm Manual selection  3 2 

SEM Glove Powered and actuated device Soft exoskeleton 3 0 

Tenoexo hand 
exoskeleton 

Powered and actuated device Semi-rigid design and EMG control 3 0 

Odstock Microstim Neuromuscular electrical stimulation EMG control 2 2 

TIGER Powered and actuated device Table-based interface and rigid 2 0 

DTSaM Orthosis Powered and actuated device Soft exoskeleton 1 0 

Fesia Grasp Device FES EMG control 1 0 

Handy Rehab Powered and actuated device Rigid exoskeleton 1 2 

Benik splint* Customisable orthosis Soft orthosis 1 1 

Dmo Lycra gloves* Customisable orthosis Soft orthosis 1 1 

Ergonomic kitchen tools* Customised tools Singular function 1 1 

Meta grip cmc splint* Customisable orthosis Rigid orthotics  1 1 

PneuGlove Powered and actuated device Soft exoskeleton 1 0 

SCRIPT Active Orthosis Powered and actuated device Rigid exoskeleton 1 0 

SNU Exo-Glove Powered and actuated device Soft exoskeleton 1 0 

Microstim Neuromuscular electrical stimulation EMG control 0 1 

NESS Handmaster Neuromuscular electrical stimulation Manual selection  0 1 

Note *Devices abstracted from text response 

 

Table 3: Main theme and subthemes: opinions and experiences of 13 AHPs on assistive devices for hands and wrists.  

Main theme Sub-theme 
Mentions 

(n) 
Defining Statement (occupation, country, experience in years) 

Device 
Design 

Function 5 “Multifunctional use, patients won’t use it if it helps with only 1[activity]” (HT/OT, 33, USA) * 

Comfort 2 
“In my experience, if an AD is not extremely comfortable and easy to use, they usually end up not being 
used.” (HT/OT, 6, USA) 

Durability 2 “Ability of the patient to obtain a replacement or extra items” (HT/OT, 50, USA) 

Weight 1 
“If they do not have proximal strength to be able to lift and manipulate the device, what good is it?” (HT/OT, 
32, USA) 

Awareness 

Lack of 
experience 

3 
“Very limited experience unfortunately - I could have used more information/experience to treat patients” 
(HT/OT, 1, USA) 

Lack of 
knowledge 

3 “I am not familiar with the list of adaptive equipment in your international list.” (HT/OT, 43, USA) 

Prescription 
Unclear 
methods 

5 “Need for clearly defined way to assess if patient is appropriate for the assistive device” (HT/OT, 40, USA) 

User Adaption 4 
“Patients are very quick to adapt their movements after an injury, and if they can use the opposite hand, 
they figure out how to quickly without the need of adapted equipment to assist.” (HT/OT, 6, USA) 

Cost 
Cost 
efficient 
alternatives 

2 
“Many times just putting a wrist and hand in a more functional position through static custom splint 
fabrication can be a low-cost and effective way to address many ADL goals.” (HT/OT, 32, USA) 

 

 

https://doi.org/10.33137/cpoj.v7i1.43790


 

9 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

Figure 1: Importance of design features based on Likert scale responses. 

Table 4: Outcome measures and tools AHPs have experience using and which they recommend, alongside discrepancies between what is 

recommended and what has been experienced.   

Outcome measures and tools 

Outcome 
measures AHPs 
have experience 

with (n) 

Outcome measures 
AHPs recommend 

using for hand/wrist 
assessment (n) 

Difference in 
recommended 
tools against 
experienced 

Range of Motion tests 49 43 -6 

Pain (self-reported) 45 41 -4 

Disabilities of the Arm Shoulder and Hand Questionnaire (DASH) 43 38 -5 

Nine Hole Peg Test (9HPT) 42 30 -12 

Purdue Pegboard test (PPT) 36 15 -21 

Jebsen-Taylor Hand Function tests (JTHFT) 28 12 -16 

Other (please specify) 17 13 -4 

Ashworth scale 12 6 -6 

Box and Blocks Test (BBT) 11 7 -4 

Motor Assessment Scale (MAS) 5 3 -2 

Southampton Hand Assessment Procedure (SHAP) 5 2 -3 

Force Control tests 3 5 2 

Patient-Rated Wrist Evaluation (PRWE)* 3 2 -1 

The Minnesota manual dexterity test (MRMT)* 3 0 -3 

Upper Extremity Functional Index* 3 2 -1 

Fugl-Meyer Assessment (FMA) 2 1 -1 

Functional Dexterity Test* 2 2 0 

Patient rate wrist/hand evaluation (PRWHE)* 2 2 0 

Patient-Specific Functional Scale (PSFS)* 2 3 1 

Quick DASH* 2 0 -2 

Action Research Arm Test (ARAT) 1 0 -1 

Corbett Targeted Coin Test* 1 1 0 

Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) 1 0 -1 

Grooved peg test* 1 1 0 

Mankoski Pain Scale* 1 0 -1 

modified Moberg* 1 0 -1 

Neck and Upper Limb Index (NULI)* 1 0 -1 

pinch/grasp strength* 1 1 0 

Shoulder Pain and Disability Index (SPADI)* 1 0 -1 

Sollermans* 1 0 -1 

The Michigan Hand Outcomes Questionnaire (MHQ) 1 1 0 

Thumb Disability Examination (TDX)* 1 0 -1 

Timed functional tasks* 1 1 0 

Wolf Motor Function Test (WMFT) 1 0 -1 

Depends on condition* 0 1 1 

Note: * Outcome measures abstracted from text response 

 

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10 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Table 5: Main factors limiting AHPs from assessing outcomes for 

patients requiring hand and wrist assistive devices. 

Limiting factors  
Mentions 

(n) 
Respondents affected 
by limiting factor (%) 

Time with patients 37 63 

Lack of equipment  27 45 

Lack of skills or training 21 35 

None* 3 5 

Cost* 2 3 

Hygiene protocols* 1 2 

Inappropriate use* 1 2 

 
Note: * Factors abstracted from text response 
 

 

DISCUSSION 

Principal findings 

The study aimed to explore barriers and limitations of 

prescribing actuated assistive devices using a cross-

sectional survey of allied health professionals. The results 

indicate that respondents did not recognise nor have 

experience using state-of-the-art actuated assistive 

devices, they also had concerns about the design of the 

devices and methods of prescription. The survey 

investigated validation methods used by AHPs and 

concerns about the functionality and relevance were 

prevalent. AHPs lacked time with patients, equipment and 

training to conduct outcome measures for using assistive 

devices, furthering the barriers for prescribing these 

devices.  

87 responses were collected, with 60 complete responses. 

These respondents were AHPs across the globe from the 

USA, the UK, Switzerland, South Africa, Nigeria, and 

Ireland. They supported patients with a multitude of 

conditions, yet these patients were not all suitable for an 

upper limb actuated device based on current treatment 

methods.  

Common features of the assistive devices recognised and 

recommended use a form of electrical stimulation and are 

distributed in the American marketplace. We can conclude 

that the US-centric perspective (72% of respondents, 43/60) 

influenced results, this was noticed in how devices are 

financed, the reduced importance of the cost of devices, and 

how financing influences outcome measures. The cost of 

the devices was considered a less important factor when 

prescribing an assistive device likely due to the purchasing 

method of devices. 

TENS and EMG devices were expected to be well 

recognised as they have a long history of use28 compared to 

the state-of-the-art nature of actuated assistive devices.29 

The wealth of evidence to support TENS and the large 

selection of devices easily available for purchase makes it 

an accessible device for self-funded US citizens. In addition 

to self-funded citizens, privately funded services would 

prioritize FDA-approved medical devices30 which may 

reduce the stock of international market options for assistive 

devices, in turn reducing accessibility.  

The responses in Table 3 address the importance of 

awareness of new technology, the design of the device, how 

to prescribe devices and user’s adaption to not requiring a 

device. As muscle weakness and pain affect people 

differently, devices must be chosen to best suit the needs of 

the user. An actuated device may fulfil user’s requirements, 

but decision-making methods for selecting actuated devices 

are not readily available. Frameworks for selecting assistive 

technology devices will likely be modified overtime to 

incorporate actuated devices,31 and the mechanical 

functionality of these devices varies vastly which makes 

being aware of all the different styles very difficult. Some 

AHPs were unfamiliar with the actuated devices listed in 

Table 2 and suggested they would research on a case-by-

case basis for a device, if it would seem useful for a patient. 

The process of researching and prescribing a device 

uniquely for a patient is an appropriate method, but time with 

patients is a considerable barrier (Table 5 and Table 6). One-

time visits are a considerable limitation for supporting 

potential assistive device users, especially if aiming to use 

Table 6: Main themes: opinions and experiences of 29 AHPs on outcome measures for hands and wrists. 

Theme Defining Statement (occupation, country, experience in years) Mentions (n) 

Functionality  
“Basic self-reported outcome measures like QuickDASH don't distinguish one hand vs two for the activities.” (HT, 
USA, 42)* 

20 

Relevance 
“outcome measures are important to demonstrate that what we are doing in therapy is being effective. I have yet 
to find one that is really good. We use the Quick DASH because our physicians use it” (HT/OT, USA, 40) 

15 

Documentation 
“We need a standardised assessment to help compare between patients but also document a patient's own 
journey” (Orthotist, UK, 12) 

9 

Time 
“if we are seeing them for a one-time visit (more and more common in the US), then where is the time for an 
outcome study?” (HT/OT, USA, 32) 

6 

Inclusiveness 
“Every patient is unique in their injury and their needs, and outcome measurements should better accommodate 
for this.” (HT/OT, USA, 6) 

5 

Financing  
“useful if funding source understands the assessment. I usually document the rational of the measure for the 
funding source and try to compare the patient's abilities with individuals without the problem.” (HT/OT, USA, 50) 

4 

*(Occupation, country, and experience in years) 

https://doi.org/10.33137/cpoj.v7i1.43790


 

11 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

outcome measures as quoted in Table 6. This poses an 

additional constraint to documenting a patient’s 

improvements and any comparison of their functionality with 

a baseline. As time is an obstacle for both assessing a 

user's functionality and researching which device would be 

useful, it is important to understand how to reduce time 

spent on these tasks. 

Outcome measures were used to assess patient’s needs, 

yet thematic analysis (Table 6) showed that the outcome 

measures used in the workplace did not capture the 

patient’s functionality. There is an immense list of outcome 

measures available, but decision-making varied in the 

demographic groups. Some AHPs chose relevant validation 

methods whereas some were decided for them by funding 

sources. Therefore, depending on how much time the AHP 

had with a patient, finding a relevant outcome measure that 

checks user functionality is a barrier. In addition, the patient 

may only have a one-time visit therefore the process of 

assessing how well the assistive device functions for the 

user does not get recorded and limits clinical evidence 

available for their use.  

To reduce these limitations, 3 suggestions could be 

investigated for future research: 1) develop a decision-

making tool to help AHPs select appropriate outcome 

measures based on the available time and equipment;  

2) adapt existing, well-established outcome measures to 

enhance their relevance; or 3) provide patients with a 

quantitative, longitudinal outcome measure tool to track 

their functionality and experiences with the actuated device.  

The limitations in using outcome measures focused on lack 

of time, equipment and training. These barriers are reflected 

in literature in the fields of physical therapy,32 hand therapy33  

and AHPs.34 To see if this was reflected in the outcome 

measures, Table 7 shows that the more commonly used 

outcome measures do not take a considerable time to 

complete (average 14 minutes), nor require complex 

equipment. However, Table 7 assumes the outcome 

measurement tools are set up and only one test is 

conducted per visit which is unrealistic. The potential 

contrasting views on the limitations of outcome measures 

(Table 5 and Table 6) and the ones used in the workplace 

(Table 7) were not questioned as part of the survey, 

therefore, it is hard to distinguish the source of the contrast. 

But a reoccurring theme for those who used outcome 

measures was that when time, equipment and training were 

not a limitation, the outcome measurement tools chosen 

were still often irrelevant and did not adequately assess 

users' functionality. 

Limitations 

This cross-sectional study has several limitations to 

consider. Due to the methodology, self-reported data and 

 

Table 7: A breakdown of the top ten most experienced outcome measures shown in Table 4: equipment, cost, time and skill required to 

complete. 

Outcome measures and 
tools 

Equipment Cost (£, $) Time (minutes) Skill level* References 

Range of Motion tests   Goniometer and inclinometer 
£15, $5-

$100 
10 Medium 35,36 

Pain (self-reported)   Paper or screen 0 10 low 37,38 

DASH Paper or screen 0 5-10 low 39-41 

9HPT 9-hole peg test kit and stopwatch 
£9.99-£75, 

$84 
5 low 42,43 

PPT Purdue pegboard and stopwatch £200, $150 5-10 low 44,45 

JTHFT 
Test kit (stopwatch, chair, table, paper, clipboard, 
cards, coffee can, paperclips, beans, spoon, board, 
clamp, red wooden checkers, cans) 

£335, $300-
$500 

30 Medium 46,47 

Ashworth scale Paper or screen 0 15 Medium 48 

BBT   Wooden box, wooden cubes, partition stopwatch £250, $200 5-10 low 49,50 

MAS 
Test kit (stopwatch, jellybeans, cup, rubber ball, 
stool, comb, spoon, pen, teacups, water, jar, table) 

Estimated 
£58.8, $77 

15 Medium 51,52 

SHAP   

Test kit (backboard, door handle and zip, shape 
form-board, foam insert, timer unit, lightweight 
abstract objects, heavyweight abstract objects, lock 
and key, zip, coins, buttons, plasticine block, knife, 
notecard, glass jar with lid, glass jug, cardboard 
juice carton, empty tin with plastic lid, metal arrow 
unit, screwdriver) 

£2150, 
$2833 

20 Medium 53 

Note: *Skill level is assumed low if data collected is observational   

 

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12 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

convenience sampling may lead to overgeneralization of 

results. The sample was not fully representative of all upper 

limb assistive device prescribers and assessors. However, 

this limitation highlights the barriers to prescribing and 

assessing these devices faced by our participants, which 

warrants further investigation with more stakeholders. 

Despite international dissemination, there was a high 

percentage of American participants, limiting comparisons 

with other countries. This was partly due to the larger size 

of the ASHT mailing list (7,000+ members) compared to 

other associations (<3,000 members). The US-centric 

perspective did reveal how financing influences the 

assistive technology marketplace and outcome measure 

decisions. This underscores the need for future research to 

include surveys of non-AHP stakeholders, such as users, 

manufacturers, and policymakers. 

The survey questions, which incorporated previous 

literature for curating lists and validated methods like 

QUEST 2.0 for design factors of importance, may have 

lacked flexibility and potentially influenced respondents. 

However, text fields were provided for additional responses, 

and results showed that these factors did not significantly 

influence responses, particularly regarding actuated 

devices which had low levels of recognisability. 

Despite these limitations, our study identifies factors 

influencing the prescription and validation of actuated upper 

limb devices. Future research could address improving the 

stakeholder representation and should tailor the 

methodology and questions to be more inclusive of factors 

missed within this study. 

CONCLUSION 

A cross-sectional survey quantifying AHPs perspectives on 

assistive devices and outcome measures was conducted. 

We identified important factors for prescribing an actuated 

device. These factors include design requirements, 

awareness of devices and decision-making support. The 

population who responded to our survey found many 

assistive devices to be uncomfortable for users, too heavy, 

not versatile enough and that users would adapt to not 

needing one. For an actuated device the weight, cost of the 

device, mechanical power and portability were considered 

not as important as other design features. Results showed 

this may be due to the respondents’ lack of exposure to 

actuated assistive devices and unclear methods to 

prescribe a relevant device. In addition, for this group of 

AHPs, their patient population may not find an actuated 

device functional or relevant. Our study also shows that 

outcome measures were rarely used to assess assistive 

devices, which means their clinical evidence will not 

increase to improve market exposure.  

Conducting outcome measures for patients faced many 

limitations. AHPs found these tools useful, but due to time 

constraints, and lack of equipment and training, they were 

not used regularly. Respondents wanted to use these tools 

to track the user's functionality, but patients may only attend 

a one-time visit. To better support AHPs, decision-making 

tools, training and modifying outcome measures would be 

appropriate. Increasing the market presence of actuated 

devices would also increase stakeholder engagement. In 

the future, researchers should use validation methods that 

tackle wearability, comfort, user satisfaction, safety and 

ease of use of their device. These validation methods 

should encompass observational outcomes used in clinical 

settings and users' perspectives. 

ACKNOWLEDGEMENTS 

We would like to acknowledge the funding and support from the 

University of Strathclyde and the UK Engineering and Physical 

Sciences Research Council (EP /S02249X). 

DECLARATION OF CONFLICTING INTERESTS 

 The authors declare no conflict of interest.   

 

AUTHORS CONTRIBUTION 

Angel Galbert: Study conception and design, data collection, 

analysis and interpretation of results, draft manuscript preparation, 

and manuscript revision. 

Arjan Buis: Supervision, study conception and design, and 

manuscript revision 

All authors have read and approved the final submitted manuscript. 

 

SOURCES OF SUPPORT 

ESPRC doctoral training grant (EP/S02249X/) 

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Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
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Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

 

APPENDIX  

 

Survey Flow 

▪ PERMISSIONS (2 Questions) 

▪ DEMOGRAPHICS (5 Questions) 

▪ ASSISTIVE DEVICES (10 Questions) 

▪ OUTCOME MEASURES (8 Questions) 

 

▪ PERMISSIONS 

Q1: Participant Information Sheet 
  

Name of department: Biomedical Engineering 

Title of the study: Analysis of current hand and wrist assistive devices, and requirements for a future device 

  

Introduction  

My name is Angel Galbert, and I am a PhD student within the department of Biomedical Engineering at the University of Strathclyde, 

Glasgow, United Kingdom. I am undertaking this study as part of my research in hand and wrist assistive devices. I am conducting XXXXX 

research under the supervision of Chief Investigator – Arjan Buis, department of Biomedical Engineering. 

  

What is the purpose of this research?  

According to the National Institute for Health and Care Excellence (NICE), the population of those affected by muscle weakness in the hands 

and wrist continues to grow. Conditions such as stroke, spinal cord injury paralysis, Parkinson’s disease and cerebral palsy have shown to 

affect the hand and wrist ability to function in activities of daily living and therefore reduce quality of life. Assistive devices are being 

incorporated in the retraining and recovery for some of these conditions, but rehabilitation treatment and assistance may be required outside 

of a clinical setting. Assistive devices may also provide additional strength, function and prehension to users wanting independence and 

support. 

  

Previous studies have designed assistive devices that can be used in everyday life in the form of exoskeletons and powered orthoses. These 

devices show mechanical potential but lack clinical outcome measures when testing. The lack of clinical outcome measures makes it difficult 

to assess usability. It also makes assistive devices difficult to compare for decision making when prescribing. 

  

This research aims to determine the requirements for an assistive device for use in everyday living by gathering opinions on current devices, 

user needs and outcome measures. This research will provide the foundations for designing a device with a user-centred approach. 

  

Do you have to take part?  

No. You do not have to take part as participation is voluntary. If you do not wish to take part in the study, there is no consequences of doing 

so. You have the right to withdraw from the research without detriment. 

  

What will you do in the project?  

You will begin by following a link to the survey. The consent form is on the first page of the survey. Please answer the questions on the 

consent form to confirm that you understand. If you give consent to take part in the study, you will click the button to continue and will be 

directed on to the survey questions. If you decline to give consent, you will be able to navigate out of the survey. The survey includes 

questions about your background, experience with hand and wrist assistive devices and upper limb outcome measures. You will also be 

invited to share your general thoughts on hand and wrist assistive devices. The survey should take no longer than 15 minutes to complete. 

The screen will state “Thank you for completing the survey” to mark the end of the survey and confirm that your responses have been saved. 

The survey will be live until December 4th, 2023, and you will be able to take the survey at any point within this period. No monetary 

incentive will be provided for taking part in the survey. As the survey is online, there are no expenses associated with travel costs. 

  

Who should take part?  

We are looking for participants who work or have worked with persons with muscle weakness in the hands and wrist. You should have 

experience of this work within the past 5 years. This may include, but is not limited to, hand therapists, orthotists, prosthetists, occupational 

therapists, physiotherapists, personal trainer, rehab specialist, assistive technology consultant, medical sales representative, engineers, 

nurses, doctors, or surgeons. Participants must be able to read and comprehend English. 

What information is being collected in the project? 

Information collected includes your experience with hand and/or wrist assistive devices, your experience with upper limb outcome measures, 

and opinion on requirements for an assistive device. None of the information collected will be identifiable. Who will have access to the 

information? The study is conducted in lines with the University General Data Protection Regulation (GDPR) Policy. The University Privacy 

https://doi.org/10.33137/cpoj.v7i1.43790


 

16 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Notice can be found online on the following website: 

https://www.strath.ac.uk/research/researchknowledgeexchangeservices/universityethicscommittee/informationsheetconsentform/ 

Information that you provide will remain confidential. All data will be stored on a secure platform accessed only by the investigators. Only 

non-identifiable information will be used when findings from the study are shared. 

  

Where will the information be stored and how long will it be kept for? 

Data obtained from this study will be stored on the University’s secure platform and accessed only by named researchers. Access and 

destruction of the data will be according to the University of Strathclyde Data Protection Policy and GDPR. As the data is anonymous, the 

consent form and anonymous data may be kept indefinitely. 

  

What happens next? 

Thank you for your attention and time reading the Participant Information. 

  

If you would like to find out more about the project or wish to ask questions before participation, please contact the researchers. 

Your responses to the survey will be anonymous. The results of this study will be reported in the researcher’s (Angel Galbert) PhD thesis and 

may be published in other academic papers, presentations and/or conferences. As the survey is anonymous, the identities of the participants 

are unknown to investigators and will therefore not be published. 

  

Researcher contact details:  

Angel Galbert, PhD student 

Department of Biomedical Engineering, University of Strathclyde.  

Email: Angel.Galbert@Strath.ac.uk 

Chief Investigator details: 

Arjan Buis, Reader 

Department of Biomedical Engineering, University of Strathclyde. 

Email: Arjan.Buis@Strath.ac.uk 

 

This research was granted ethical approval by the Department of Biomedical Engineering Ethics Committee, University of Strathclyde. 

  

If you have any questions/concerns, during or after the research, or wish to contact an independent person to whom any questions may be 

directed or further information may be sought from, please contact: 

  

Linda Gilmour 

Secretary to the Departmental Ethics Committee, Department of Biomedical Engineering, University of Strathclyde. 

Tel: 0141 548 3298 

Email: Linda.Gilmour@Strath.ac.uk 

o I confirm I have read the participant information sheet (1)  

 

 

Q2: Consent Form  
  

Please read of the following statements and check the box below to confirm: 

 - I confirm that I have read and understood the Participant Information Sheet for the above project and the researcher has answered any 

queries to my satisfaction. 

  

  - I confirm that I have read and understood the Privacy Notice for Participants in Research Projects 

(https://www.strath.ac.uk/research/researchknowledgeexchangeservices/universityethicscommittee/informationsheetconsentform/) and 

understand how my personal information will be used and what will happen to it (i.e. how it will be stored and for how long). 

  

  - I understand that my participation is voluntary and that I am free to withdraw from the project at any time, up to the point of completion, 

without having to give a reason and without any consequences. 

  

 -  I understand that anonymised data (i.e. data that do not identify me personally) cannot be withdrawn once they have been included in the 

study. 

-  I understand that any information recorded in the research will remain confidential and no information that identifies me will be made 

publicly available. 

o Yes. I consent to being a participant in the project. (1)  

o No. I do not consent to being a participant in the project. (2)  

Skip To: End of Survey If Q2 = No. I do not consent to being a participant in the project. 

 

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https://doi.org/10.33137/cpoj.v7i1.43790
https://www.strath.ac.uk/research/researchknowledgeexchangeservices/universityethicscommittee/informationsheetconsentform/
mailto:Angel.Galbert@Strath.ac.uk
mailto:Arjan.Buis@Strath.ac.uk
mailto:Linda.Gilmour@Strath.ac.uk


 

17 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

▪ DEMOGRAPHICS 

Q3: What is your occupation? 

o Assistive Technology Consultant (1)  

o Hand Therapist (2)  

o Health Care Assistant (HCA) (3)  

o Medical Doctor (4)  

o Nurse Specialist (5) 

o  Occupational Therapist (6)  

o Orthotist (7)  

o Physiotherapist (8)  

o Prosthetist (9) 

o  Rehabilitation Specialist (10) 

o  Other (please specify) (11)  

 

Q4: Have you worked in this field within the last 5 years?  

o Yes (1) 

o  No (2)  

Skip To: End of Survey If Q4 = No 

 

Q5: How long have you worked in this occupation? (please provide answer in years) 

Q6: In which country do you currently work? 

Q7: Which patient population(s) do you interact with?  

o Carpal tunnel syndrome (1) 

o  Cerebral palsy (2) 

o  Duchenne muscular dystrophy (3) 

o  Epicondylitis (4) 

o  Multiple sclerosis (5)  

o Parkinson's disease (6) 

o Peripheral neuropathy (7)  

o Sarcopenia (8)  

o Spinal Cord Injury (9)  

o Stroke (10)  

o Other (please specify) (11) __________________________________________________ 

 

 

▪ ASSISTIVE DEVICES 

Q8: Do you prescribe assistive devices for hands and wrists?  

o Yes (1) 

o  No (2)  

Q9: Do you assess assistive devices for hands and wrists? 

o Yes (1) 

o  No (2)  

 

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18 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Q10: Which assistive device(s) have you heard of? 

o ArmMotus (1)  

o DTSaM Orthosis (2)  

o EXOTIC exoskeleton (3)  

o Fesia Grasp Device (4)  

o Gloreha Lite glove (5)  

o GraspyGlove (6)  

o Hand of Hope (7)  

o Handy Rehab (8)  

o INTFES (9)  

o JACO (10)  

o MAHI EXO (11) 

o MeCFES (12)  

o Microstim (13)  

o MyoPro Orthosis (14)  

o NESS Handmaster (15) 

o  Odstock (16)  

o PneuGlove (17)  

o ReHand (18) 

o  ReIn-Hand system (19)  

o RUPERT (20)  

o SaeboMAS (21)  

o SCRIPT Active Orthosis (22)   

o SEM Glove (23)  

o SNU Exo-Glove (24)  

o Tenoexo hand exoskeleton (25)  

o TENS Stimulator (26)  

o TIGER (27)  

o X-Glove (28)  

o None (29)  

o Other (please specify) (30) ______________________________________________ 

Display This Question: If Q8 = Yes 

Q11: Which assistive device(s) have you worked with? 

o ArmMotus (1) 

o DTSaM Orthosis (2)  

o EXOTIC exoskeleton (3) 

o Fesia Grasp Device (4)  

o Gloreha Lite glove (5)  

o GraspyGlove (6)  

o Hand of Hope (7)  

o Handy Rehab (8)  

o INTFES (9)  

o JACO (10)  

o MAHI EXO (11)  

o MeCFES (12)  

o Microstim (13)  

o MyoPro Orthosis (14)  

o NESS Handmaster (15) 

o  Odstock (16) 

o PneuGlove (17)  

o ReHand (18) 

o  ReIn-Hand system (19)  

o RUPERT (20)  

o SaeboMAS  (21)  

o SCRIPT Active Orthosis (22)  

o SEM Glove (23)  

o SNU Exo-Glove (24)  

o Tenoexo hand exoskeleton (25)  

o TENS Stimulator (26)  

o TIGER (27) 

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19 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

o  X-Glove (28) 

o Other (please specify) (29) __________________________________________________ 

Display This Question: If Q8 = No 

Q12: Do you offer assistive devices for hands and wrists in your workplace? 

o Yes (1)  

o No (2)  

Display This Question: If Q12 = Yes 

Q13: Which assistive device(s) are offered in your workplace? 

o ArmMotus (1) 

o DTSaM Orthosis (2)  

o EXOTIC exoskeleton (3) 

o Fesia Grasp Device (4)  

o Gloreha Lite glove (5)  

o GraspyGlove (6)  

o Hand of Hope (7)  

o Handy Rehab (8)  

o INTFES (9)  

o JACO (10)  

o MAHI EXO (11)  

o MeCFES (12)  

o Microstim (13)  

o MyoPro Orthosis (14)  

o NESS Handmaster (15) 

o  Odstock (16) 

o PneuGlove (17)  

o ReHand (18) 

o  ReIn-Hand system (19)  

o RUPERT (20)  

o SaeboMAS  (21)  

o SCRIPT Active Orthosis (22)  

o SEM Glove (23)  

o SNU Exo-Glove (24)  

o Tenoexo hand exoskeleton (25)  

o TENS Stimulator (26)  

o TIGER (27) 

o  X-Glove (28) 

o Other (please specify) (29) __________________________________________________ 

 

Display This Question: If Q12 = No 

Q14: Why not? 

 

 

Q15: Do you feel you have enough access to assistive devices for hands and wrists? 

o Definitely yes (1)  

o Probably yes (2)  

o May or may not (3)  

o Probably not (4)  

o Definitely not (5)  

 

 

 

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20 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Display This Question:  
If Q8 = Yes 
Or Q9 = Yes 
Or Q12 = Yes 

 

Q16: In your opinion, which factors are most important when assessing an assistive device? 

 
Not at all 

important (1) 
Slightly important 

(2) 
Moderately 

important (3) 
Very important 

(4) 
Extremely 

important (5) 

Cost of device (1)       

Ease of use (2)       

Mechanical power (3)       

Portability (4)       

Safety (5)       

User satisfaction (6)       

Wearability and comfort (7)       

Weight (8)       

 

Q17: Please add any additional comments about your opinions and experiences of assistive devices for hands and 
wrists 

 
 
 

▪ OUTCOME MEASURES 

Q18: Do you have experience using outcome measures for upper limb assessment? 

o Yes (1)  

o Some experience (2)  

o No (3)  

Display This Question: If Q18!= No 

Q19: Which outcome measure(s) do you have experience with? 

o Action Research Arm Test (ARAT) (1)  

o Ashworth scale (2)  

o Box and Blocks Test (BBT) (3)  

o Disabilities of the Arm Shoulder and Hand Questionnaire (DASH) (4)  

o Force Control tests (5)  

o Fugl-Meyer Assessment (FMA) (6)  

o Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) (7) 

o Jebsen-Taylor Hand Function tests (JTHFT) (8)  

o Motor Activity Log (MAL) (9)  

o Motor Assessment Scale (MAS) (10)  

o Nine Hole Peg Test (9HPT) (11)  

o Pain (self-reported) (12)  

o Purdue Pegboard test (PPT) (13) 

o  Range of Motion tests (14)  

o Southampton Hand Assessment Procedure (SHAP) (15)  

o Wolf Motor Function Test (WMFT) (16) 

o Other (please specify) (17) _______________________________________________ 

 

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21 

Galbert A, Buis A. Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals. Canadian 
Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.4. https://doi.org/10.33137/cpoj.v7i1.43790 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X FACTORS IN PRESCRIBING ACTUATED UPPER LIMB DEVICES: A SURVEY OF ALLIED HEALTH PROFESSIONALS 

Galbert A, and Buis A, 2024 

Display This Question: If Q18!= No 

Q20: Which outcome measure(s) do you recommend using for hand and/or wrist assessment? 

 

o Action Research Arm Test (ARAT) (1)  

o Ashworth scale (2)  

o Box and Blocks Test (BBT) (3)  

o Disabilities of the Arm Shoulder and Hand Questionnaire (DASH) (4)  

o Force Control tests (5)  

o Fugl-Meyer Assessment (FMA) (6)  

o Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) (7) 

o Jebsen-Taylor Hand Function tests (JTHFT) (8)  

o Motor Activity Log (MAL) (9)  

o Motor Assessment Scale (MAS) (10)  

o Nine Hole Peg Test (9HPT) (11)  

o Pain (self-reported) (12)  

o Purdue Pegboard test (PPT) (13) 

o  Range of Motion tests (14)  

o Southampton Hand Assessment Procedure (SHAP) (15)  

o Wolf Motor Function Test (WMFT) (16) 

o None (17) 

o Other (please specify) (18)  

Q21: What do you feel are the main limitations to assessing outcomes for patients requiring hand and wrist 

assistive devices? 

o Time with patients (1)  

o Lack of skills or training (2)  

o Lack of equipment (3)  

o Other (please explain) (4) __________________________________________________ 

Q22: In your opinion, are outcome measurement tools useful for patients requiring assistive devices? 

o Yes (1)  

o Unsure (2)  

o No (3)  

Q23: In your opinion, could outcome measurement tools be improved for patients requiring assistive devices? 

o Yes (1)  

o Unsure (2)  

o No (3)  

Display This Question: If Q23 = Yes 

Q24: Please give a short explanation as to why/how outcome measures could be improved for assessing assistive 

devices for hands and wrists 

 
 

 

 

 

Q25: Please add any additional comments about your opinions and experiences with outcome measures 

 

 

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