Mobile Videoconferencing for Occupational Therapists’ Assessments of Patients’ Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study

Abstract

Background Occupational therapists who work in hospitals need to assess patients’ home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients’ home environments could be an innovative solution to allow better and more appropriate recommendations. Objective The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients’ home environments. Methods Occupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients’ homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient’s occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews. Results Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not. Conclusions The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning. International Registered Report Identifier (IRRID) RR2-10.2196/11674

Caregiver Support Role in Occupational Therapy Video Telehealth

“…One of the remaining 2 studies involving home safety included older hospitalized patients41 (ages 68-90) with an average 39-day hospital stay from primarily orthopedic conditions and with a planned discharge home. Families received 2 types of home safety evaluations (1 traditional and 1 virtual).…”

“…Caregiver inclusion criteria only specified that caregivers had to be able to orally communicate and walk without assistance. Participating caregivers were mostly female (7 of 8, or 87.5%), 36 to 80 years old, and were the patients' spouse (n = 3), adult child (n = 3), or sibling (n = 1) 41…”

“…Several studies also noted the benefits of caregiver participation, including that caregiver involvement in care planning increased family-centered care. 31,32,41,42 Some caregivers assumed a more active role in goal setting and problem-solving in telehealth than in traditional care. 42 Caregiver participation also allowed for treating patients in their natural context.…”

The smart-home study: A feasibility study to pilot the use of smartphone technology to identify environmental falls risk factors in the home

“…This was an ethical related limitation as the protocol needed to be shown to be feasible prior to targeting a more vulnerable population. Recent studies have had similar challenges in recruitment (Latulippe et al, 2022). In reality, the baseline conditions of individuals are necessary for occupational therapists to determine their functional capability, including mobility and transfers (Griffin & McConnell, 2001).…”

“…We differentiate our work as it was conducted in Australia, a land of great geographical distances and variable internet connections. Indeed video conferencing has recently been explored by others (Latulippe et al, 2022) and concluded that smartphones may have potential. Photos can be stored to be assessed at a time suitable for a therapist.…”