Determinants of Telerehabilitation Acceptance among Patients Attending Pulmonary Rehabilitation Programs in the United States.

BACKGROUND: Pulmonary rehabilitation (PR) is an interdisciplinary intervention designed to improve the physical status and the psychological condition of people with chronic respiratory diseases. To improve patients' participation in PR programs, telerehabilitation has been introduced. OBJECTIVE: This study aimed to identify factors that could influence the intention to use telerehabilitation among patients attending traditional PR programs. METHODS: This cross-sectional study recruited subjects attending the PR centers in the hospitals of the Indiana State University, United States of America, between January and May 2017. Data were collected using self-administered Tele-Pulmonary Rehabilitation Acceptance Scale (TPRAS). TPRAS had two subscales: perceived usefulness and perceived ease of use. Behavioral intention (BI) was the dependent variable, and all responses were dichotomized into positive and negative intention to use. Multiple logistic regressions were performed to assess the influence of variables on the intention to use telerehabilitation. RESULTS: A total of 134 respondents were included in this study, of which 61.2% indicated positive intention to use telerehabilitation. Perceived usefulness was a significant predictor of the positive intentions to use of telerehabilitation. Duration of respiratory disease was negatively associated with the use of telerehabilitation. CONCLUSION: Perceived usefulness was a significant predictor of using telerehabilitation. The findings of this study may be useful for health-care organizations in improving the adoption of telerehabilitation or in its implementation. Future telerehabilitation acceptance studies could explore the effects of additional factors including computer literacy and culture on the intention to use telerehabilitation.

Health Care Practitioners' Determinants of Telerehabilitation Acceptance.

BACKGROUND: Pulmonary rehabilitation is a multidisciplinary patient-tailored intervention that aims to improve the physical and psychological condition of people with chronic respiratory diseases. Providing pulmonary rehabilitation (PR) services to the growing population of patients is challenging due to shortages in health care practitioners and pulmonary rehabilitation programs. Telerehabilitation has the potential to address this shortage in practitioners and PR programs as well as improve patients' participation and adherence. This study's purpose was to identify and evaluate the influences of intention of health care practitioners to use telerehabilitation. METHODS: Data were collected through a self-administered Internet-based survey. RESULTS: Surveys were completed by 222 health care practitioners working in pulmonary rehabilitation with 79% having a positive intention to use telerehabilitation. Specifically, perceived usefulness was a significant individual predictor of positive intentions to use telerehabilitation. CONCLUSION: Perceived usefulness may be an important factor associated with health care providers' intent to use telerehabilitation for pulmonary rehabilitation.

Development and Validation of the Tele-Pulmonary Rehabilitation Acceptance Scale.

BACKGROUND: Using telehealth in pulmonary rehabilitation (telerehabilitation) is a new field of health-care practice. To successfully implement a telerehabilitation program, measures of acceptance of this new type of program need to be assessed among potential users. The purpose of this study was to develop a scale to measure acceptance of using telerehabilitation by health-care practitioners and patients. METHODS: Three objectives were met (a) constructing a modified scale of the technology acceptance model, (b) judging the items for content validity, and (c) judging the scale for face validity. Nine experts agreed to participate and evaluate item relevance to theoretical definitions of domains. To establish face validity, 7 health-care practitioners and 5 patients were interviewed to provide feedback about the scale's clarity and ease of reading. RESULTS: The final items were divided into 2 scales that reflected the health-care practitioner and patient responses. Each scale included 3 subscales: perceived usefulness, perceived ease of use, and behavioral intention. CONCLUSIONS: The 2 scales, each with 3 subscales, exhibited evidence of content validity and face validity. The 17-item telerehabilitation acceptance scale for health-care practitioners and the 13-item telerehabilitation acceptance scale among patients warrant further psychometric testing as valuable measures for pulmonary rehabilitation programs.

Alcohol intoxication progressively impairs drivers' capacity to detect important environmental stimuli.

RATIONALE: Alcohol intoxication impairs driving skills, leading to an increased frequency of accidents and crash fatalities. Inebriation may specifically impair environmental vigilance, reducing the driver's capacity for attention to stimuli that are relevant to successful navigation. OBJECTIVES: We examined the separate and interactive effects of breath alcohol concentration (BrAC) and simulated driving scenario on the capacity to correctly identify visual stimuli embedded in the environment. METHODS: Ten healthy young adult drivers (6 males; 4 females) each performed 4 driving scenarios at each of 3 steady breath alcohol concentration levels (0, 60 and 100 mg/dl). Scenarios were based on speed or distance keeping while navigating a rural 2-lane road in daytime or nighttime conditions. Drivers pressed a button on the steering wheel corresponding to the direction of an arrow (up or down) which appeared briefly on road signs embedded in the environment, either overhead or on the roadside. RESULTS: Increasing level of BrAC and subjective scenario difficulty manifested significant, separate, but not interactive influences in association with the number of arrows correctly identified. Significant impairments could be detected at a level of BrAC below the current American limit for legal operation of a motor vehicle. CONCLUSIONS: Environmental vigilance is subject to impairment by either/both alcohol intoxication and driving conditions.

Occupational therapy interventions to promote driving and community mobility for older adults with low vision: a systematic review.

A systematic literature review was conducted to evaluate the effectiveness of interventions within the scope of occupational therapy practice to improve or maintain the driving performance and community mobility of older adults with low vision. The results of this review identified a limited number of articles-eight-that met the inclusion criteria. Identified intervention strategies included the use of bioptics or prisms, multidisciplinary vision rehabilitation for community mobility, driving simulator training, driver education programs, and orientation and mobility training. Evidence is insufficient for the effectiveness of these interventions in improving or maintaining the driving performance or community mobility of older adults with low vision. Key study limitations included heterogeneity of sample characteristics (age, type of vision impairment), lack of standardization of interventions (device type, time, intensity duration), and lack of standardized assessments to measure driving and community mobility. This evidence-based review is informative for discussion of practice, education, and research implications.

Caregiver and noncaregiver attitudes toward dementia screening.

OBJECTIVES: To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving. DESIGN: A cross-sectional study. SETTING: Primary care clinics in Indianapolis, Indiana. PARTICIPANTS: Eighty-one participants with dementia caregiving experience (CG) and a random sample of 125 participants without dementia caregiving experience (NCG). MEASUREMENTS: Attitudes of dementia screening, including acceptance of dementia screening and its perceived harms and benefits, as determined according to the Perceptions Regarding Investigational Screening for Memory in Primary Care questionnaire. RESULTS: After adjusting for age, race, sex, and education, CGs had a lower dementia screening acceptance mean score (53.9 vs 60.6; P=.03) and a higher perceived suffering score (61.6 vs 55.9, P=.04) than NCGs, but there were no differences in perceived benefits of dementia screening (72.8 vs 69.0; P=.50), perceived stigma (32.9 vs 37.5; P=.12), and perceived negative effect on independence (47.6 vs 54.0; P=.20). The top three barriers to screening identified by both groups were emotional suffering by the family (86% of CGs and 75% of NCGs), loss of driving privileges (75% of CGs and 78% of NCGs), and becoming depressed (64% of CGs and 43% of NCGs). CONCLUSION: The experience of being a dementia caregiver may influence one's own attitude about accepting dementia screening for oneself.

Patients' attitudes of dementia screening across the Atlantic.

BACKGROUND: Dementia is a common and growing global public health problem. It leads to a high burden of suffering for society with an annual cost of $100 billion in the US and $10 billion in the UK. New strategies for both treatment and prevention of dementia are currently being developed. Implementation of these strategies will depend on the presence of a viable community or primary care based dementia screening and diagnosis program and patient acceptance of such a program. OBJECTIVE: To compare the acceptance, perceived harms and perceived benefits of dementia screening among older adults receiving their care in two different primary health care systems in two countries. DESIGN: A Cross-sectional study. SETTING: Primary care clinics in Indianapolis, USA and Kent, UK. PARTICIPANTS: A convenience sample of 245 older adults (Indianapolis, n = 125; Kent, n = 120). OUTCOMES: Acceptance of dementia screening and its perceived harms and benefits as determined by a 52-item questionnaire (PRISM-PC questionnaire). RESULTS: Four of the five domains were significantly different across the two samples. The UK sample had significantly higher dementia screening acceptance scores (p < 0.05); higher perceived stigma scores (p < 0.05); higher perceived loss of independence scores (p < 0.01); and higher perceived suffering scores (p < 0.01) than the US sample. Both groups perceived dementia screening as beneficial (p = 0.218). After controlling for prior experience with dementia, acceptance and stigma were marginalized. CONCLUSIONS: Older adults attending primary care clinics across the Atlantic value dementia screening but have significant concerns about dementia screening although these concerns differed between the two countries. Low acceptance rates and high rates of perceived harms might be a significant barrier for the introduction of treatment or preventive methods for dementia in the future.

Predictability of clinical assessments for driving performance.

PROBLEM: As the number of older drivers grows, it is increasingly important to accurately identify at-risk drivers. This study tested clinical assessments predictive of real-time driving performance. METHOD: Selected assessment tools considered important in the identification of at-risk older drivers represented the domains of vision, cognition, motor performance, and driving knowledge. Participants were administered the battery of assessments followed by an on-road test. A univariate analysis was conducted to identify significant factors (<.05) to be included in a multivariate regression model. RESULTS: Assessments identified as independently associated with driving performance in the regression model included: FACTTM Contrast sensitivity slide-B, Rapid Pace Walk, UFOV rating, and MMSE total score. DISCUSSION: The domains of vision, cognitive, and motor performance were represented in the predictive model. SUMMARY: Due to the dynamic nature of the driving task, it is not likely that a single assessment tool will identify at risk drivers. IMPACT ON INDUSTRY: By standardizing the selection of clinical assessments used in driving evaluations, practitioners should be able to provide services more efficiently, more objectively, and more accurately to identify at-risk drivers.

Changes in impairment level, functional status, and use of assistive devices by older people with depressive symptoms.

OBJECTIVE: We sought to understand how functional status, impairment level, and use of assistive devices change over 3 years for older adults with depressive symptoms. We further explored factors that predict change in severity of depressive symptoms. METHOD: This study used data from the Rehabilitation Engineering Research Center on Aging Consumer Assessment Study, a longitudinal study of coping strategies of elders with disabilities. Seventy-three participants with depressive symptoms were interviewed at baseline and 3 years later. RESULTS: During 3 years, participants experienced increased physical disability (p = .001), a decline in severity of depressive symptoms (p = .03), and an increase in the total number of assistive devices owned. CONCLUSION: A significant number of older adults will experience a decrease in depressive symptoms over 3 years, despite an increase in physical disability. They also will obtain more assistive devices as they age.

Problems with dressing in the frail elderly.

OBJECTIVE: Dressing is an important activity of daily living, yet many older adults have difficulty due to impairments. The purpose of this study was to explore the use of assistive devices for dressing by older persons with impairments, and to look at differences among frail elders with no dressing difficulty, upper-extremity-only dressing difficulty, lower-extremity-only dressing difficulty, and both upper- and lower-extremity dressing difficulty. METHOD: We conducted in-home interviews and functional assessments with 1,101 elderly persons with activities of daily living and/or instrumental activities of daily living limitations in Western New York and Northern Florida. Participants were assigned to one of four groups based on Functional Independence Measure item scores for upper-extremity dressing and lower-extremity dressing. Descriptive statistics were used to report results. RESULTS: Compared to women, there were relatively more men with lower-extremity dressing difficulty than with upper-extremity dressing difficulty. The group with both upper- and lower-extremity dressing difficulty reported the highest level of pain and scored lowest on all measures of functional status and mental status. The most commonly used dressing devices were associated with lower-extremity dressing. CONCLUSION: There are differences in gender, health status, functional status, and mental status among elderly persons grouped by upper- or lower-extremity dressing difficulty. Results suggest that therapists should consider such differences as gender and type of difficulty (upper- or lower-extremity dressing) in both therapeutic approaches and recommendations for assistive devices. Pain is another important consideration, but it can often be reduced during dressing by using assistive devices.

Grip strength in the frail elderly.

OBJECTIVE: To explore the relationship of impairment types to grip strength in the live-at-home frail elderly. DESIGN: All data in this cross-sectional study were collected in face-to-face interviews in subjects' homes by a nurse or occupational therapist. A total of 832 elders with activity limitations, as determined by the FIM instrument, participated in the study. Subjects were divided into three age groups (60-69, 70-79, and 80+ yrs) and four impairment groups: (1) minimally impaired, (2) visually impaired, (3) motor impaired, and (4) cognitively impaired. The outcome measures included the average (in kilograms) of three grip-strength trials per hand measured with the Jamar dynamometer at the second handle setting. RESULTS: There were significant differences in grip strength scores among all age groups, indicating that grip strength decreased with age. Among impairment groups, the minimally impaired and visually impaired groups had significantly greater grip strength scores than the motor-impaired and the cognitively impaired groups. There were no significant differences between the minimally impaired and visually impaired groups or between the motor-impaired and the cognitively impaired groups. CONCLUSIONS: Age and sex are not the only determining factors of grip strength in the frail elderly. The type of impairment affects grip strength as well. Thus, age-based norms may not be the only basis for interpreting evaluation data and establishing treatment goals with this population.

Dissatisfaction and nonuse of assistive devices among frail elders.

This article is based on the Rehabilitation Engineering Research Center on Aging Consumer Assessments Study. The sample included 1,056 subjects who reported use or nonuse of assistive devices. Of these subjects, 873 identified reasons for not using or being dissatisfied with certain assistive devices. Study participants owned a mean of 14.2 assistive devices, used 84.8% of the devices they owned, and were satisfied with 84.2% of the devices they owned. Devices were grouped into categories based on the type of impairment they addressed (hearing, vision, cognitive, and musculoskeletal/neuromotor). Study participants owned the largest number of devices in the musculoskeletal/neuromotor category (mean of 10.6 devices). Devices in the hearing impairment category were rated lowest by participants in terms of satisfaction. Almost half of all reasons listed for not using certain assistive devices related to perceived lack of need.