Abstract:Introduction While occupational therapy home assessments are effective to identify environmental falls risk factors, patients may not receive these services due to workforce distribution and geographical distances. Technology may offer a new way for occupational therapists to conduct home assessments to identify environmental fall risks. Objectives To (i) explore the feasability of identifying environmental risk factors using smartphone technology, (ii) develop and pilot a suite of procedures for taking smartp… Show more
“…In the future intervention design, people who are available at home (e.g., relatives) could therefore perform the home scan. There is some evidence of good feasibility in using smartphone technology for taking and submitting photos for the therapeutic assessment for those in community dwelling (Leung & Brandis, 2023). However, only adults under 75 years of age in the community were recruited for this purpose.…”
Background
Pre-discharge home assessments (PDHA) aim to identify environmental barriers to patients’ activities, to recommend and provide aids and home modifications and to assess activity performance within “real life conditions”. PDHA are time consuming. Virtual approaches might overcome these obstacles.
Aim
This study aimed to develop a technical system (ReTho) supporting ward-based PDHA within the virtual twin of the real patients´ home and to evaluate the feasibility of the Virtual Reality (VR)-PDHA within clinical processes.
Methods
ReTho was developed within 11 months involving users (workshops, pre-pilot testing, usability testing groups, interviews) to achieve usability and fit of the intervention to the context. ReTho comprised a smartphone-home scan, a data backend with interface to organize data and applications to measure the home as a 3D model on desktop and immersively in VR. Feasibility and acceptance of the intervention and feasibility of study processes were testet as single-arm study in an inpatient rehabilitation clinic.
Results
Twelve patients (neurological diagnoses n=11, geriatric diagnosis n=1) received the intervention. The scan took between 40 and 90 minutes per patient. Per PDHA, on average 7.76 (SD 1.97) rooms were assessed. Therapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. On average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. Data collection procedures were feasible with minor implications for improvement.
Therapists rated satisfaction in usability and usefulness of the tool overall as very good. ReTho had the potential to enable tailored recommendations and advice on home modifications/aids, to increase patients’ acceptance of recommendations and to improve activity goals. Information flow and communication within the discharge preparation process was not enhanced due to misssing interfaces between the system and the clinic IT. Performance and satisfaction with activities increased slightly after discharge (4.41 to 5.3 and 4.53 to 4.90). The fear of falling remained consistent.
Conclusions:
The study demonstrates the clinical feasibility of ReTho. The system goes beyond functions of other previously known applications for PDHA. Further intervention development concerns the connection of process stakeholders in the rehabilitation context inside and outside the ward setting.
Trial Registration: Study registration of the pilot study occurred prior to inclusion of the first study participant as DRKS00025836 in a publicly accessible study registry (German Clinical Trials Register).
“…In the future intervention design, people who are available at home (e.g., relatives) could therefore perform the home scan. There is some evidence of good feasibility in using smartphone technology for taking and submitting photos for the therapeutic assessment for those in community dwelling (Leung & Brandis, 2023). However, only adults under 75 years of age in the community were recruited for this purpose.…”
Background
Pre-discharge home assessments (PDHA) aim to identify environmental barriers to patients’ activities, to recommend and provide aids and home modifications and to assess activity performance within “real life conditions”. PDHA are time consuming. Virtual approaches might overcome these obstacles.
Aim
This study aimed to develop a technical system (ReTho) supporting ward-based PDHA within the virtual twin of the real patients´ home and to evaluate the feasibility of the Virtual Reality (VR)-PDHA within clinical processes.
Methods
ReTho was developed within 11 months involving users (workshops, pre-pilot testing, usability testing groups, interviews) to achieve usability and fit of the intervention to the context. ReTho comprised a smartphone-home scan, a data backend with interface to organize data and applications to measure the home as a 3D model on desktop and immersively in VR. Feasibility and acceptance of the intervention and feasibility of study processes were testet as single-arm study in an inpatient rehabilitation clinic.
Results
Twelve patients (neurological diagnoses n=11, geriatric diagnosis n=1) received the intervention. The scan took between 40 and 90 minutes per patient. Per PDHA, on average 7.76 (SD 1.97) rooms were assessed. Therapy sessions took 43.67 (SD 10.52, range from 25 to 65) minutes in total. On average 12.42 (SD 5.02) recommendations per patient were given, and on average 36% (SD 21%) of them were ongoing two weeks after discharge. Data collection procedures were feasible with minor implications for improvement.
Therapists rated satisfaction in usability and usefulness of the tool overall as very good. ReTho had the potential to enable tailored recommendations and advice on home modifications/aids, to increase patients’ acceptance of recommendations and to improve activity goals. Information flow and communication within the discharge preparation process was not enhanced due to misssing interfaces between the system and the clinic IT. Performance and satisfaction with activities increased slightly after discharge (4.41 to 5.3 and 4.53 to 4.90). The fear of falling remained consistent.
Conclusions:
The study demonstrates the clinical feasibility of ReTho. The system goes beyond functions of other previously known applications for PDHA. Further intervention development concerns the connection of process stakeholders in the rehabilitation context inside and outside the ward setting.
Trial Registration: Study registration of the pilot study occurred prior to inclusion of the first study participant as DRKS00025836 in a publicly accessible study registry (German Clinical Trials Register).
IntroductionVisiting a patient's living environment is important for occupational therapists, albeit costly and time consuming. MapIt is a mobile app producing a 3D representation of a home with the possibility of taking measurements. The purpose of this study was to explore the utility of a 3D representation of a patient's home for the clinical practice of occupational therapists.MethodsCase study in which the unit of analysis was the utility of MapIt as defined by ISO 9241‐11:2018 and as perceived by occupational therapists in four different occupational therapy clinical settings (Canada). Onsite observations with 10 occupational therapists (and their patients) were triangulated with data from interviews, diaries, and logbooks. Inductive thematic condensation led to emerging conclusions for each clinical setting, fuelling the next case data collection and analysis. Inter‐case analysis was corroborated by additional occupational therapists, through crowdsourcing and expert review.ResultsOccupational therapists' clinical reasoning was supported by the MapIt app, enhancing and streamlining their work and inducing adjustments to treatment plans. Occupational therapists saw and measured the patient's environment remotely, to better match person‐environment‐occupation and promote occupational engagement. MapIt's 3D representations were judged useful to communicate between occupational therapists and stakeholders, to educate, allow continuity, optimise resources, minimise the patient's time on a waitlist for homecare, and save time for everyone.DiscussionMapIt allowed occupational therapists who performed home visits to bring a little of the patients' home to their office, whereas occupational therapists without access to the home could see it and take measurements. MapIt's utility was confirmed for practice in clinical settings and for better continuity of care between settings.ConclusionMapIt makes it possible for occupational therapists to ‘walk around’ the patient's home remotely, but the possibility of measuring environmental elements is a 3D model's true added value over currently used photos or short videos.
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