Date Presented 4/21/2018
It is feasible to provide telehealth home modification interventions using participant-owned devices to improve home safety and perception of performance. Telehealth has the potential to improve access to home modification services, and therefore large-scale studies are warranted.
Primary Author and Speaker: Marnie Renda
PURPOSE: Occupational therapy home modification interventions have been shown to improve home safety, reduce risk of falls, improve functional performance, and delay institutionalization. Access to these services is restricted, however, because of the limited number of occupational therapy practitioners, large geographic areas, and cost of services, leading to delays or inability to access services. The need for services will increase with the rise in the U.S. aging population and incidence of chronic illness and with the shift toward community-based care. The purpose of this study was to determine the effectiveness of using a smartphone, tablet, or computer to deliver telehealth occupational therapy home modification interventions to improve home safety and perceptions of performance of daily activities in adults and older adults living at home.
METHOD: This quasi-experimental, pretest–posttest design study examined an intervention administered over 8 wk using the Doxy.me (Rochester, NY) telehealth platform. Participants were referred by neurologists in Cincinnati, Ohio, who learned about the project from an informational email and phone call. Participant inclusion criteria were age 18 or older; difficulty completing one activity of daily living; access to a smartphone, tablet, or computer; lived in Ohio or Kentucky; spoke English; and had an individual (technology assistant) available to position the electronic device during sessions. The exclusion criterion was a medical power of attorney. Technology assistant inclusion criteria were ability to hold and reposition the smartphone, tablet, or computer with instructions; comfort using the device; ability to safely access all areas of the home; and familiarity with how the participant completed daily activities.
Four participants, two men and two women aged 43–80, completed the study. All participants had a neuromuscular disorder, used assistive mobility devices, and had a history of multiple falls within the past year. Standardized assessment tools were the Safety Assessment of Function and the Environment for Rehabilitation–Health Outcome Measurement and Evaluation v.3 to measure home safety and the Canadian Occupational Performance Measure to measure changes in perception of performance.
RESULTS: All participants showed improvement in home safety and perceptions of performance. The average home safety change score was –20, indicating improved home safety. Each participant had improved perception of performance of an average of 5.25 problems, with an average improved satisfaction score of 5.2. All participants indicated that the interventions were effective, addressed their individual needs, and eliminated the burden associated with leaving home for a health care appointment and that they would recommend and participate again in telehealth visits.
CONCLUSION: It is feasible to provide telehealth occupational therapy home modification services using a smartphone, tablet, or computer to improve home safety and perception of performance. Results support previous studies that found that low-bandwidth videoconferencing software could be used to administer telehealth occupational therapy services using a technology staff member to manage the hardware and software (Hoffman et al., 2008; Nakamura et al., 1999; Sanford et al., 2006, 2007). In this study, a combination of synchronous and asynchronous services were used because of slowed audio and video processing speed, and the use of technology assistants to record video resulted in poor-quality videos at times. Despite these challenges, all participants demonstrated improvements in home safety and perception of performance and stated they would recommend telehealth services to others.
IMPACT STATEMENT: This study suggests that telehealth home modification interventions can improve home safety and perception of performance. Further investigation into the benefits of telehealth services is warranted to expand access to services.
References
Hoffman, T., Russell, T., Thompson, L., Vincent, A., & Nelson, M. (2008). Using the Internet to assess activities of daily living and hand function in people with Parkinson’s disease. Neurorehabilitation, 23, 253–261.
Nakamura, K., Takano, T., & Akao, C. (1999). The effectiveness of videophones in home healthcare for the elderly. Medical Care, 37, 117–125.
Sanford, J. A., Griffiths, P. C., Richardson, P., Hargraves, K., Butterfield, T., & Hoenig, H. (2006). The effects of in-home rehabilitation on task self-efficacy in mobility-impaired adults: A randomized clinical trial. Journal of the American Geriatrics Society, 54, 1641–1648. http://doi.org/10.1111/j.1532-5415.2006.00913.x
Sanford, J. A., Hoenig, H., Griffiths, P. C., Butterfield, T., Richardson, P., & Hargraves, K. (2007). A comparison of televideo and traditional in-home rehabilitation in mobility impaired older adults. Physical and Occupational Therapy in Geriatrics, 25(3), 1–18. https://doi.org/10.1080/J148v25n03_01
