Global availability of guidelines related to assistive technology: a scoping review

Abstract

Background:

Given the rising global demand for assistive technology, predicted to encompass 3.5 billion people by 2050, understanding the availability of guidelines governing its use and identifying potential gaps is paramount.

Objective:

This scoping review mapped existing guidelines related to assistive technology. The review aimed to inform future research and guideline development to accelerate access to assistive technology within universal health coverage.

Methods:

Following the JBI methodology, a systematic search of guidelines published between January 2008 and March 2024 was conducted across CINAHL, Google Scholar, PubMed, TRIP and WHO IRIS. Included guidelines related to specific assistive technology, including product types and services for users and their caregivers. Guidelines targeting system-level interventions were excluded.

Results:

The search identified 291 records, of which 24 guidelines were included. They focus on improving health outcomes for diverse populations across different healthcare settings. Most guidelines originated from high-income countries and predominantly addressed commonly known assistive products for mobility, hearing, vision, and self-care. There is a gap in guidelines for assistive products for cognition and communication. The identified guidelines primarily followed evidence-based methodologies and involved assistive technology users in their development.

Conclusions:

This review provides a crucial overview of the existing landscape of assistive technology guidelines. It calls for further action to harmonize standards, leverage innovation in evidence generation, and enhance guideline development to better serve the global population in need of assistive technology.

1 Introduction

Assistive technology refers to products and their related systems and services designed to enhance health and well-being, especially for individuals with disabilities, older adults, and those living with chronic health conditions (1). Assistive products include physical devices such as wheelchairs, spectacles, hearing aids, prostheses, and digital applications that support interpersonal communication and daily activities as well as environmental adaptations such as ramps and grab-rails (1, 2). According to the 2022 Global Report on Assistive Technology (3), around 2.5 billion people worldwide need at least one assistive product, a figure projected to rise to over 3.5 billion by 2050. However, access to assistive technology (i.e., people having the needed assistive products as a proportion of the population in need) varies significantly and is below 5% in some countries (3).

The 71st World Health Assembly resolution (WHA 71.8) called for Member States to develop, implement and strengthen policies and programs, to improve access to assistive technology within universal health and social services coverage (4). The resolution underscores the need for establishing national lists of priority assistive products that are affordable and meet minimum quality and safety standards.

While the International Organization for Standardization (ISO) has classified over 900 types of assistive products, providing an extensive reference for different health conditions (2), WHO introduced the Priority Assistive Products List (APL) in 2016 (1). Aiming to improve access to assistive technology globally, the APL prioritizes 50 products with widespread need and the greatest impact on people's lives. The ISO and WHO lists serve as resources, but the wide array of products and lack of guidance on implementing and monitoring their provision can challenge national adaptation and policymaking. Despite progress in country initiatives (5), many countries struggle to fully implement policies or monitor their impact due to noticeable workforce and service delivery gaps (3, 6).

Guidelines, according to World Health Organization, are any document containing recommendations for clinical practice or public health policy (7), are crucial for translating evidence into policies and practices for assistive technology. The global emphasis on improving access to assistive technology highlights the need for a clearer understanding of existing guidelines and areas for improvement. Despite numerous assistive products and a growing global demand, a gap remains in comprehensive, accessible guidance for policymakers and practitioners. A preliminary literature search conducted in July 2023, using terms related to “assistive products” and “guidelines” in databases such as PubMed and the Cochrane Database, revealed no comprehensive reviews on this topic. Thus, there is a need for a scoping review aiming to map existing guidelines related to assistive technology and to identify resources and gaps in available guidelines. It would support policymakers, practitioners, and researchers by offering an overview of existing guidelines and highlighting the gaps that require further exploration. By mapping the existing resources, a review would inform guideline developers, including the WHO and other stakeholders, on priority areas for future research and normative work in assistive technology. Addressing the existing gaps and understanding national and international best practices are essential for shaping effective, equitable policies that enhance accessibility and meet the needs of an aging, increasingly diverse population.

2 Methods

2.1 Protocol and registration

This review followed the JBI methodology for scoping reviews (8). The review protocol was registered on 23 May 2024 in the Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/FV7J8). The protocol was updated on 3 June 2024,¹ revising the title of the review to focus on the global availability of the guidelines. This update was justified to better reflect the scope of the review questions and the data extraction plan. The reporting of the scoping review was guided by the PRISMA-ScR (9).

2.2 Eligibility criteria

Guidelines either in English or available in English translation and published between January 2008 and March 2024 were eligible for inclusion. Considering the rapid advancements in assistive technology development, such as innovations brought by smartphones, wearables, and artificial intelligence in healthcare, guidelines from the past 15 years should have captured the most relevant and up-to-date recommendations of interest for this review.

2.3 Information sources

The sources searched included health science publication outlets with a specific filter on clinical practice guidelines, including PubMed, CINAHL, TRIP, and WHO IRIS. In addition, Google Scholar was searched to complement the aforementioned outlets for any relevant guidelines. The final search strategy and terms were piloted and improved in collaboration with an experienced librarian from the University of Oxford. All searches were conducted in April 2024.

2.4 Search

An initial limited search of PubMed and TRIP medical database (10) was executed using broad terms of “assistive technology” or “assistive products” or “assistive devices” and filter “guidelines” to identify records on the topic. The initial search yielded few relevant guidelines. Augmenting the search with terms presenting the functional domains: “cognition”, “communication”, “continence”, “hearing”, “mobility”, “self-care” and “vision” led to more relevant guidelines. Index terms from these relevant guidelines, such as “disability”, “ageing”, “chronic diseases”, “occupational therapy” as well as specific assistive product types identified as having a high prevalence of population need from the most recent surveys (3, 11, 12) were included in the search terms to capture relevant guidelines. In Supplementary Material I, the complete search strategy for each included database is presented.

2.5 Selection of sources of evidence

Citations were imported into Zotero 6.0.62 to generate BibTex files, which were subsequently imported to Rayyan (13), an online systematic review support software, for systematic screening. Duplicates were identified by Rayyan using its automatic detection algorithm. Each identified duplicate was examined before removal. Keywords as used in the search terms, such as types of assistive products and functional domains, were highlighted in the title and abstracts by Rayyan to assist the screening. A document was identified as a guideline for this review when the term “guideline” was used to describe the work in the title or body of the text.

The reference lists of the included guidelines were reviewed, and potentially relevant citations were retrieved and screened for inclusion by the first author (WZ).

2.6 Data charting process

2.7 Data items

To systematically chart extracted data in a structured format, a table with 16 columns was developed (see Supplementary Material III).

2.8 Synthesis of results

Quantitative data on type of organization, country of organization, year, functional domain, and context are summarized in bar and pie charts. Key themes, trends, and gaps were identified and are narratively described in a structured manner by the review questions.

3 Results

3.1 Selection and characteristics of sources of evidence

The search returned 72 records from PubMed, 41 from CINAHL, 86 from TRIP, and 13 from WHO IRIS. Records returned in the first 11 pages (10 records per page) in the search of Google Scholar were scanned and 103 records were imported to Rayyan successfully.² The reason to stop scanning after 11 pages was because fewer records' titles were found relevant after that. The search resulted in 315 records in total. After 24 duplicates were removed, 291 records were left for screening. Out of these records, 84 of the records' titles and abstracts were found relevant to the inclusion criteria, and their full documents were sought. Fourteen of these records could not be retrieved in full due to either the full text not being found (n = 10) or not being available in English (n = 4). Among the 70 full texts screened, 52 were excluded because these documents did not explicitly discuss any assistive product or related services or assistive technology in general (n = 35), were background papers (n = 1), or were not guidelines (n = 16). One guidance statement (14) was included because it was developed specifically based on existing guidelines. Another document (15) was included as it provided comprehensive information from its original guideline published by the Japan Audiological Society, whose full English translation could not be retrieved. Hence, 18 of the 70 full texts were included in the review. While screening the full texts, 16 new records were found relevant through citation searches. After screening the full texts of these additional documents, 6 were added to the review (excluding background papers: n = 1, not explicitly discussing assistive technology: n = 1, and non-guideline: n = 8). Finally, 24 relevant guidelines published in the past 15 years were identified. The full data extraction from the guidelines is presented in Table 1. Figure 1 presents the search results and the screening process through a PRISMA flow diagram for scoping review (9).

Figure 1

Data extraction was verified by GPT-4o on 10 records (42% of the total reviewed records). These guidelines are oriented around health condition (such as falls, stroke, osteoporosis, urinary incontinence, etc.) instead of assistive technology, and the conditions likely concerned multiple assistive product interventions. Among the verified records, discrepancies were found in two records. GPT-4o identified vaginal pessaries (16) and electrical stimulator (17), which were not identified by the author. These two products fall under the definition of assistive products and the ISO 9999 classification. Hence, they were included in the data extraction.

Figure 2 illustrates the general demographic information of these guidelines, including the year of publication, the countries, and the types of developing organizations. Figure 3 summarizes the distributions of functional domains and care settings addressed by the identified guidelines related to assistive technology. Findings responding to the review questions on the availability of guidelines are summarized in the following subsections, with discussions deepening into the types of products and services covered, populations and typical health conditions addressed, applicable healthcare settings for interventions, as well as the methodologies used for the development of these guidelines.

Figure 2

Figure 3

3.2 Availability of guidelines related to assistive technology

National health professional organizations, predominantly from high- and upper-middle-income countries [USA (n = 9), UK (n = 2), France (n = 2), Australia (n = 2), Japan (n = 1) and Thailand (n = 1)], have been instrumental in producing guidelines for assistive technology. Of the 24 identified guidelines, 11 were created by professional associations in fields like audiology, geriatrics, physical medicine, and rehabilitation. These guidelines, including contributions from the WHO, which collaborated with international professional associations, aim to establish high standards for screening, assessment, and intervention in assistive technology. The primary aim of these guidelines is to improve health outcomes by providing systematic methods for selecting and utilizing assistive products, though some also address system-level outcomes, including the enhancement of national service provision and regulation of product standards.

Guidelines published by international professional association (n = 1) and WHO (n = 6), generally developed in collaboration with other agencies, tend to have an international scope, with some (n = 2) addressing specific needs in low-resource or low-income settings (18, 19). Guidelines developed by national organizations often target the unique needs of their country's population, though some are adapted for broader applicability.

3.3 Assistive products and related services covered

Guidelines predominantly cover mobility products (n = 14), which include wheelchairs, walking aids, orthoses, and prostheses. This is followed by those for hearing (n = 6), self-care (n = 4), vision (n = 4), continence (n = 2), and environment-modification (n = 2). One guideline recommends assistive technology in general (20). Cognitive and communication products are notably absent, indicating a gap in assistive technology guidelines for these functions. Eight guidelines include recommendations of assistive products for more than one functional domain.

Most guidelines, especially those focusing on mobility and hearing products, emphasize the importance of individualized assessments to ensure that devices are matched to user needs. These assessments are crucial in adjusting products to fit the users and providing training to optimize the products' benefits. Some guidelines provide detailed protocols for managing the provision of specific assistive products, such as wheelchairs or orthoses, which include steps for design, production, qualification of the workforce, and policy considerations (18, 21–24). Guidelines on wheelchair provision (22), for example, outline proper fitting procedures, recommended materials, and user training to maximize mobility benefits. Less specificity is found in guidelines where assistive technology is one element of a broader intervention package, such as those addressing self-care, incontinence, or environmental accessibility improvements (25, 26). Majority (21 of 24) guidelines recommend that users' preferences and values be considered during the selection and delivery of assistive products.

3.4 Populations addressed

Several identified guidelines specifically address adults living with chronic health conditions or disabilities, such as those with stroke (17), osteoarthritis (27, 28), cognitive impairment (29), hearing loss (30), chronic primary low back pain (31) and acquired upper limb amputations (32). Older adults are often a key demographic, with guidelines targeting them for assistive products like mobility aids (14, 33) and fall prevention measures (34). According to one guideline (27), older people should not be prescribed bifocal or multifocal spectacles for outdoor use due to an increased risk of falls. Two guidelines address the assistive technology applications for children, focusing on early childhood development (35) and managing conditions like developmental dysplasia of the hip (36). Female adults are the target population in two guidelines focused on osteoporosis (27) and urinary incontinence management (16). Students with disabilities are the focused demographic in one guideline, which recommends assistive technologies that facilitate access to education and navigation within school environments (20).

3.5 Applicable contexts

The identified guidelines address various healthcare settings, including specialty care (n = 8), primary care (n = 7) and home/community care (n = 5). The settings vary depending on the complexity of the assistive product and the severity of the user's health condition. Specialty care is mainly recommended for complex products like prostheses and hearing aids that require individualized fitting and adjustments by professionals. Primary care settings address simpler assistive products such as mobility aids, absorbent products, and alarms for emergency response, making them accessible within a community context. Guidelines suggest home and community care services are suitable for providing simple aids, like vision or mobility products, which enable easier management of daily activities. Besides healthcare settings, the education (school) environment is included in two guidelines for assistive technology provision to support learning and accessibility.

3.6 Development methods

The majority (n = 18) of the identified guidelines were developed using evidence-based methodologies that include literature reviews, evidence synthesis, and stakeholder consultations, as specified in their respective institutional development guidance. For example, the WHO handbook for guideline development (7), is the guidance framework with oversight by an organizational review committee. The framework adopts standardized evidence appraisal framework, such as GRADE (37) and AGREE II (38) to ensure methodological rigor, as several professional associations do for their guideline development. Aiming for transparency, most guidelines present recommendations based on evidence quality. However, the evidence to support recommendations for assistive products was generally weak in the reviewed guidelines. Other development methodologies include consultative and consensus-based approach (18, 21, 39), or based on principles and field validations (19), or using a qualitative research approach such as semi-structured interviews (20). Patients and caregivers' involvement in the development were discussed in some guidelines.

4 Discussions

The findings underscore assistive technology's role in managing a diverse range of health conditions across all age groups. Guidelines aimed at condition-specific interventions address assistive technology within broader treatment recommendations, reflecting its integrative role in health management. The discussion of considering users' preference in product selection and delivery by many guidelines emphasizes user-centered provision model for assistive technology.

However, the review reveals key limitations in the global landscape of assistive technology guidelines, where focus is on products for vision, hearing, mobility, and self-care. There are significant gaps in guidelines for products for cognition and communication, as well as assistive technology-specific service provision for most product categories. While evidence-based approaches are widely adopted, limitations in high-quality research on assistive technology and patients' and caregivers' involvement in guideline development process can affect the strength and the applicability of recommendations.

These findings highlight a need for more diverse guideline development for improving access to assistive technology, especially in low-resource settings. As assistive technology plays an increasing role across healthcare, especially for aging populations and those living with chronic health conditions, efforts to strengthen guidelines can contribute to more accessible, inclusive healthcare. The following discussion addresses major challenges impacting assistive technology guideline development and adoption into policies and practices. Opportunities and potential actions for improving future assistive technology research and guideline development are outlined.

4.1 Challenges in assistive technology policy and practices for health interventions

4.1.1 Ambiguity in international standards for assistive products

Inconsistency in classifications and terminologies for assistive products among international standards is most notable between the ISO 9999 and the WHO APL—the two most prominently referenced standards in the field. Challenges also arises due to incomplete information as neither abovementioned list provides clear descriptions of the included products. Lack of clarity and inconsistency create ambiguity and makes communication of assistive technology concepts challenging among stakeholders (40). From manufacturing, procurement, and trade to systematic evidence generation of products' safety and efficacy profiles, adopting unified international terminologies and standards is critical.

Additionally, the rapid evolution of digital technology, such as smartphones integrating assistive functions, challenges existing standards. For example, categories like video communication devices are now outdated, as many of its functions are integrated into general consumer electronic devices, and no longer exclusively used by people with disabilities. This makes the concept of assistive technology diverse beyond disability and will continue evolving (41). These discrepancies highlight the need for adaptable, future-proof terminologies and standards that can accommodate both traditional and emerging assistive products.

4.1.2 Lack of evidence-informed provision

A recent scoping review specifically on guidelines for assistive products provision had found that this topic being discussed mostly in book chapters, scientific articles or proceedings, and reports (42). The development of reliable recommendations for provision of assistive products is hampered by limited high-quality evidence (43) and the absence of standardized outcome measures (44), even in some of the most developed areas like wheelchairs (22). Lack of evidence-informed provision could be responsible for the observation of beneficiaries receiving inappropriate or unusable assistive products due to poor service provision (45). Assistive technology interventions are often complex, involving multiple products tailored to individual needs, which complicates evidence-generation based on randomized controlled trials (43).

Without consistent data, assistive technology providers struggle to make informed decisions, leading to suboptimal product selections that may not fully benefit users. In the absence of robust evidence, guideline recommendations are often broad, rather than tailored to specific products and user profiles, impacting the outcome of the intervention.

4.1.3 Inadequacy of professional workforce

Effective assistive technology provision requires specialized skills across multiple domains, yet training opportunities are limited (3, 46). Few well-established assistive technology professions, such as audiologists, opticians, orthotists, and prosthetists, focus on specific areas of assistive technology without extensive cross-functional collaboration. The shortage and siloed professions slow the advancement of cross-functional expertise and weaken the advocacy for policy and practices improvement in the field. As professional groups are a driving force for guideline development, lack of assistive technology professionals and less integrated knowledge in other health professions have left the assistive technology guidelines behind.

4.1.4 Complexity in leadership and governance for policy implementation

Implementing comprehensive assistive technology policies requires cooperation across sectors (47), which can be challenging due to fragmented governance systems, varying budget priorities, administrative and logistical constraints. Guideline implementation can also be hindered by local context, such as constraints in local and global supply chains of assistive products that limiting selection to what available on the local market than population needs. Similar to the constraints have been seen in medicines and vaccines access challenges (48). Furthermore, insufficient public financing or lack of alternative financing models for assistive technology could prevent full service provision as recommended (49). These challenges due to system complexity may demotivate leadership and inefficient governance in prosperity of assistive technology policy and practice implementation, which reversely hinder guideline development and adoption.

4.2 Opportunities for improving assistive technology guidelines and practices

4.2.1 Harmonizing norms and standards

Aligning ISO 9999, WHO's APL, and other relevant international standards, such as the International Classification of Functioning, Disability and Health (ICF), which sets international norms on risk factors used by research and clinical practices in physical medicines, rehabilitation, disability studies (50), would improve clarity and streamline assistive technology provision by establishing a consistent framework. Efforts to provide product specifications (51) and training for service provision (52) have laid groundwork for better alignment. Similarly, harmonizing outcome measures is essential for improving the quality and comparability of assistive technology impact assessments (53). Standardizing outcome measures would allow researchers and policymakers to evaluate and compare efficacy and effectiveness of different assistive products and with other health interventions (44, 54, 55) focusing on what matters (56, 57), and providing a stronger evidence base for future guidelines.

It is worth noting that harmonization of norms and standards should be continuous consultative and collaborative processes, aiming towards a common understanding and benefit from relevant and emerging concepts in health outcome measures (58), validated methods and data collection tools (59–64) to enable synergized information on assistive technology.

4.2.2 Identifying and filling evidence gaps through systematic research

Recent initiatives to review the need, benefit, risk and cost for assistive products offer pathways to enhance evidence base for resource prioritization by focusing on cost-effectiveness (65, 66). Studies on modelling the selection of assistive products (67, 68), and barriers and facilitators for delivering interventions (69–71) are critical to advance evidence-informed provision to improve user-centered outcomes. Addressing evidence gaps will require diverse research methodologies, including observational studies and qualitative assessments, to capture real-world usage and its impact on daily life. Such evidence would enable guidelines to provide more specific, actionable recommendations for assistive product provision.

Initiatives on innovative and fit-for-purpose research methodologies could be another cornerstone to advance clinical practices in assistive technology. Opportunities for health research are to be taken to expand from traditional lab-bound and centralized research environment to versatile contexts and decentralized manner. Boosting research and evidence generation with advanced data availability and growing analytical power could derive useful recommendations in the absence of RCTs.

4.2.3 Advancing practice with living guidelines

Implementing a “living guidelines” approach (72), where recommendations are continuously updated with emerging evidence, could help bridge gaps in assistive technology guidance. The WHO has successfully used this approach for COVID-19 guidelines (73) and other areas of work (74), showing its potential for fast-evolving fields like assistive technology. Living guidelines would allow recommendations to evolve in line with technological advancements, such as AI-enabled assistive products, ensuring that practitioners always have access to current, evidence-based guidance. Regular updates would benefit practitioners and policymakers alike, facilitating timely decision-making and better health outcomes for users.

4.2.4 Raising awareness

Initiatives such as the World Day for Assistive Technology are crucial for building awareness about assistive technology needs, especially in low- and middle-income countries (75). By highlighting unmet needs, these campaigns can help mobilize resources and advocate for stronger policies. Increased awareness can also engage communities, policymakers, and healthcare providers, reinforcing the importance of access as a fundamental healthcare service and enhancing funding opportunities. Such campaigns are opportunities to bring all relevant stakeholders together to highlight the multi-sectoral efforts needed for improving assistive technology access for health, education, and social welfare. Adopting a system thinking for policy and practices, as well as the guideline development at its start, is key to delivering interventions to make positive impact on assistive technology users (76).

4.3 Actions for stakeholders

Including assistive technology in universal health coverage plays an essential role in the implementation of United Nations Convention on the Rights of Persons with Disabilities and achieving the Sustainable Development Goals (3, 77).

In response to WHA71.8's call, effective translation of research outcomes to policy and practices needs a joint effort of pushing evidence to practices and pulling research to address policy gaps. Assistive technology guidelines development is a key action in this intersection. Following actions are proposed to be considered by the WHO, researchers and practitioners, policymakers (such as ministries, regulators, research ethicists), and other stakeholders (such as global health and development donors, civil societies, and industry).

Researchers and practitioners are in the driving seat of developing innovative research methodology and expansion of evidence generation capturing the full scope of assistive technology impact. This will lead to improvements in provision by focusing on user-centered outcomes. For policymakers, supporting evidence-informed guidelines and policies that prioritize collaboration and user engagement can improve access (76). A coordinated, inclusive policy approach will help address gaps in provision across different sectors. Funders for research and development in assistive technology may consider enhancing resources for knowledge translation in their funding schemes, and enabling researchers' engagement with civil societies, industry, and policy makers to increase the chance of research outcomes being taken up by policy and practice. As a leading agency in global health norm and standard, WHO, with its Global Cooperation on Assistive Technology platform (78), is well-positioned to coordinate international efforts. Continued work on harmonizing and standardizing assistive technology guidelines and promoting evidence-based practices will be instrumental in expanding accessibility.

4.4 Strengths and limitations

The strengths of this review include: (1) the inclusion of a diverse range of international and national guidelines provides a broad perspective on current assistive technology practices; (2) the identification of key gaps in evidence and challenges in assistive technology guidelines; and (3) comprehensive discussions of opportunities and actions for stakeholders in future policy development and research aimed at improving evidence-informed guidelines and practices.

This review is limited by language constraints, as it only includes English-language guidelines, potentially excluding relevant local guidelines in other languages. Furthermore, it focuses on specific databases and sources, which may result in the omission of guidelines indexed in other policy document databases such as Overton (https://www.overton.io).

Future studies could consider extending the review by including guidelines in other languages than English, in more databases and grey literatures, as well as expanding search terms such as “adaptive equipment”, “accessibility equipment”, “support devices” to identify relevant guidelines, especially in underrepresented functional domains in this review.

5 Conclusions

This scoping review provides a critical overview of the current landscape of assistive technology guidelines. The findings underscore the need to expand and accelerate research and practices in the field to ensure that guidelines are grounded in robust evidence and remain relevant and effective. Furthermore, there is an urgent need for harmonized terminology and international standards to enhance the clarity, consistency and global applicability of assistive technology guidelines.

To advance assistive technology policy and practices, the review highlights the importance of continuous, coordinated, and collaborative efforts that value the perspectives of users and stakeholders in both evidence generation and guideline development. By addressing identified gaps and leveraging opportunities, stakeholders can improve the availability and quality of assistive technology guidelines, ultimately enhancing the health and well-being of people who need assistive technology worldwide.

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