Researchers led by Rina Juel Kaptain of University College of Northern Denmark and the Parker Institute, together with colleagues from the University of Southern Denmark and Greve Municipality, surveyed occupational therapists involved in assistive technology service delivery across Danish municipal units. The target population comprised the 605 occupational therapists registered as working in this system in 2021. Using snowball sampling through professional networks and municipal department heads, the team collected questionnaire data over three weeks in April 2022. In total, 224 therapists responded and 206 completed the survey, meaning roughly one-third of the entire national workforce in assistive technology provision took part. Participants represented all five regions of Denmark and spanned wide ranges of age, professional experience and tenure in their current positions.

The findings paint a picture of an assessment practice built largely on personal judgement rather than standardised procedure. Nearly all participants, 92 percent, combined telephone interviews and home visits to gather information. Fifty-nine percent said they often used telephone interviews, while 74 percent reported conducting home visits. During those visits, 95 percent combined interviewing with direct observation of the client in their own environment, though only a quarter used questionnaires as an information-gathering method. The choice of approach often depended on the type of device requested: as one participant explained, larger cases always warranted a home visit, while smaller aids such as toilet aids, walkers or grippers were frequently handled in a single phone call.

More striking still was the near-absence of formal assessment instruments. Almost two-thirds of participants, 61.2 percent, reported not using standardised assessment tools at all. Among those who did, many relied on locally created questionnaires or checklists, or borrowed fragments of established instruments. Several therapists described drawing loosely on tools such as the Assessment of Motor and Process Skills, the ADL Taxonomy, the Canadian Occupational Performance Measure and the International Classification of Functioning, Disability and Health, but rarely in their entirety. Only 4 percent reported using a standardised tool in full, 17 percent used parts of a single tool, and 38 percent mixed parts of different tools together. Roughly 78 percent said their workplace had made no decisions about which tools should be used, and almost 80 percent reported having no guidelines about tool selection at all.

These results matter because the assessment step forms the foundation of the entire service delivery process. The European assistive technology service delivery model, developed through the HEART study of the European Commission and later refined by the AAATE and EASTIN consortium in 2012, describes seven steps: initiative, assessment, selection of the assistive solution, selection of the equipment, authorisation, implementation, and management and follow-up. Assessment occupies the second step and, according to the model’s recommendations, should evaluate the client’s individual needs using standardised procedures while keeping the client’s perspective at the centre. The Danish guidelines under the Social Service Law similarly emphasise a comprehensive, concrete and individual assessment performed in close collaboration with the client, who is regarded as best placed to express their own needs.

Previous research underscores why this matters. Systematic reviews show that satisfaction with and usefulness of assistive technology increase when professionals understand clients’ needs, expectations and preferences, and involve them in identifying personal goals. Studies from Bangladesh and elsewhere demonstrate that user involvement in service delivery predicts better outcomes of assistive technology use. Conversely, research on occupational therapy evaluation shows that when assessment relies solely on self-report through unstructured interviews without observation, important information about a client’s actual daily activity performance goes missing. A recent scoping review of the WHO European region likewise identified inadequate assessment procedures as a barrier to accessing high-quality assistive technology services.

Paradoxically, despite the variability and lack of standardisation, the surveyed therapists were largely content with their practice. Nearly three-quarters felt they had the opportunity to perform a relevant assessment, and 89 percent reported being satisfied or very satisfied with how they conducted it. The authors suggest this contentment may reflect the fact that assistive technology service delivery, unlike rehabilitation practice, lacks a strong tradition of working according to occupational therapy process models. Comments from participants revealed an awareness of constraints: some cited insufficient time and resources, noting that quantity of applications often took priority over quality of professional work, while others attributed their assessment ability primarily to accumulated experience, with one noting that forty years of practice helped.

The researchers argue that the absence of workplace guidelines effectively leaves each individual therapist’s discretionary judgement to determine how every client is assessed. They point to occupational therapy frameworks such as the Occupational Therapy Intervention Process Model and the Canadian Practice Process Framework, both of which include structured assessment phases focused on understanding the relationship between a client’s occupations and their contexts. A related Danish study found that when therapists used theoretical frameworks and structured instruments, they felt more professionally competent in the service delivery process. Employing such models as the backbone of standardised procedures could, the authors suggest, enhance equality in service quality and reduce the impact of varying experience levels across therapists.

The study does carry methodological caveats. Snowball sampling risks bias, and while the questionnaire was pilot tested to establish face validity, additional pilots with therapists from more diverse municipalities would have strengthened it. Even so, the broad national representation lends weight to the conclusion. The authors call for a standard minimum guideline for comprehensive assessment within the Danish assistive technology service delivery system, and propose renewed international work toward a standardised, interdisciplinary framework for the full service delivery process, one that keeps the user central and addresses satisfaction and abandonment of devices. Future research, they suggest, should examine whether assessment practices differ by device type, how other professions conduct such assessments, and whether integrating occupational therapy process models improves the Danish system overall.

For the millions of people worldwide who depend on assistive technology to manage daily life after illness, injury or age-related decline, the study is a reminder that the quality of a wheelchair or hearing aid is only as good as the assessment behind it. Denmark’s experience suggests that even in well-resourced welfare systems, the pathway from need to device can rest on practices that are neither uniform nor evidence-informed, and that closing this gap may be one of the most consequential improvements available in assistive technology provision.

Subject of Research: How Danish occupational therapists perform comprehensive assessments in the assistive technology service delivery process

Article Title: Comprehensive assessment as part of the assistive technology service delivery process

Article References: Kaptain, R. J., Riisager, M., Juul, C., Olsen, M. R., & Wæhrens, E. E. (2025). Comprehensive assessment as part of the assistive technology service delivery process. Scandinavian Journal of Occupational Therapy, 32(1), Article 2451287. https://doi.org/10.1080/11038128.2025.2451287

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2451287

Keywords: assistive technology, occupational therapy, assessment, service delivery, Denmark, standardised assessment tools, home visits, client-centred practice, survey, guidelines, rehabilitation, ADL