Implementation of digital health technologies for older adults: a scoping review.

The critical importance of technological innovation in home care for older adults is indisputable. Less well understood is the question of how to measure its performance and impact on the delivery of healthcare to older adults who are living with chronic illness and disability. Knowing how well digital technologies, such as smartphones, tablets, wearable devices, and Ambient Assisted Living Technologies (AAL) systems "work" should certainly include assessing their impact on older adults' health and ability to function in daily living but that will not guarantee that it will necessarily be adopted by the user or implemented by a healthcare facility or the healthcare system. Technology implementation is a process of planned and guided activities to launch, introduce and support technologies in a certain context to innovate or improve healthcare, which delivers the evidence for adoption and upscaling a technology in healthcare practices. Factors in addition to user acceptance and clinical effectiveness require investigation. Failure to appreciate these factors can result in increased likelihood of technology rejection or protracted procurement decision at the "adoption decision" stage or delayed or incomplete implementation or discontinuance (following initial adoption) during implementation. The aim of our research to analyze research studies on the effectiveness of digital health technologies for older adults to answer the question, "How well do these studies address factors that affect the implementation of technology?" We found common problems with the conceptualization, design, and methodology in studies of digital technology that have contributed to the slow pace of implementation in home care and long-term care. We recommend a framework for improving the quality of research in this critical area. Systematic Review Registration: https://archive.org/details/osf-registrations-f56rb-v1, identifier osf-registrations-f56rb-v1.

Framework for policymaking on self-management of health by older adults using technologies.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, the use of information and communication technologies (ICTs) to support care management exponentially increased. Governments around the world adapted existing programs to meet the needs of patients. The reactivity of governments, however, led to changes that were inequitable, undermining groups such as older adults living with chronic diseases and disability. Policies that align with recent developments in ICTs can promote better health outcomes and innovation in care management. A framework for policymaking presents potential for overcoming barriers and gaps that exist in current policies. OBJECTIVE: The goal of this study was to examine how well a provisional framework for policymaking represented the interactions between various components of government policymaking on older adults' self-management of chronic disease and disability using ICTs. METHODS: Through an online survey, the study engaged policymakers from various ministries of the government of Ontario in the evaluation and revision of the framework. The data were analyzed using simple statistics and by interpreting written comments. RESULTS: Nine participants from three ministries in the government of Ontario responded to the questionnaire. Overall, participants described the framework as useful and identified areas for improvement and further clarification. A revised version of the framework is presented. CONCLUSIONS: Through the revision exercise, our study confirmed the relevance and usefulness for a policymaking framework on the self-management of disease and disability of older adults' using ICTs. Further inquiries should examine the application of the framework to jurisdictions other than Ontario considering the dissociated nature of Canadian provincial healthcare systems.

Psychosocial predictors of mobility assistive devices non-adherence among older adults.

Background: Mobility assistive devices (MADs) provide support to older adults to improve their quality of life; however, research shows that as many as 75% of older adults are non-adherent to prescribed MADs. This study investigated the psychosocial factors that predict non-adherence to MADs among older adults.Methods: A sample of Canadian older adult MADs users who resided in a long-term care facility was included. The data was collected using the Psychosocial Impact of Assistive Devices Scale (PIADS), and the Medical Outcomes Study Social Support Survey (mMOS-SS). Data analysis was performed using SPSS 28. Descriptive statistics were used to describe the sample and the study variables. Pearson correlation coefficients were used to evaluate the association between the study variables. Variables that were associated with non-adherence in a univariate analysis were subsequently entered into a multiple regression analysis.Results: The sample comprised 48 residents (26 females and 22 males), with a mean age of 86.8. In the univariate analysis, scores from the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, and the Social Support scale were significantly correlated with non-adherence (p < 0.05). In the multiple regression analyses, only Self-esteem significantly predicted non-adherence (p < 0.05), and this model explained between 43.5 and 54.3% of the variance in non-adherence.Conclusion: This study revealed that the Self-esteem construct, which includes several concepts related to psychological well-being, was the only significant predictor of non-adherence among the studied sample of older adults. The clinical implications of the findings are subsequently discussed.

Older adults' non-adherence to Mobility Assistive Devices (MADs) is a significant problem in Rehabilitation practice.Self-esteem can explain nearly 50% of the variance in the prediction of non-adherence to MADs among older adults.Evaluating client's Self-esteem is important for clinicians because it helps them determine and predict who will be adherent and who will need further attention.The findings of this research support the use of the Psychosocial Impact of Assistive Devices Scale in clinical practice as a means of building a relationship between the user and a professional.

Assessing virtual reality acceptance in long-term care facilities: a quantitative study with older adults.

PURPOSE: Our study aimed to investigate the factors associated with the acceptance of virtual reality (VR) games among older adults living in LTC, with a particular emphasis on identifying social and individual factors that have been overlooked in existing technology acceptance models. MATERIALS AND METHODS: We conducted VR gaming sessions, followed by a composite questionnaire to explore the factors associated with the acceptance of VR games among residents of LTC with a focus on technology acceptance models (TAM) and social factors derived from Selective Optimization with Compensation (SOC) theory and Socioemotional Selectivity Theory (SST). RESULTS: We studied 20 older adults aged 65 and older. Participants were moderately sedentary, with the majority of them having prior gaming experience. Participants with prior gaming experience had higher mean scores in most SOC theory and SST subscales, except for elective selection. Participants perceived the technology as useful and easy to use, with no heightened gaming-related anxiety. Significant correlations were found between perceived ease of use and selection strategies, and between attitudes towards gaming and elective selection strategies. No significant score differences were observed between male and female participants. CONCLUSIONS: The positive correlation between VR acceptance and using SOC strategies suggests a positive response to straightforward experiences. Our study highlights VR exergaming's potential benefits for encouraging LTC residents' engagement in valued activities and pursuing goals. Moreover, social theories of aging can inform technology acceptance and guide the design and marketing of VR exergames to better suit older adults' needs and preferences in LTC.IMPLICATIONS FOR REHABILITATIONThe findings of this study have important implications for rehabilitation programs aimed at enhancing physical activity (PA) and engagement among older adults living in long-term care (LTC) facilities. The use of virtual reality (VR) games can be an important tool to promote PA and improve the overall well-being of LTC residents. Based on the results, the following implications can be drawn:Integrating VR exergaming in rehabilitation:The positive perception of VR technology's usefulness and ease of use among older adults in LTC suggests that VR exergaming can be effectively integrated into rehabilitation programs. Healthcare professionals and rehabilitation specialists in LTC facilities can consider incorporating VR-based exercise routines and gaming sessions to motivate and engage residents in physical activities. By doing so, they can create enjoyable and interactive rehabilitation experiences that may lead to improved adherence to exercise regimens.Addressing social factors for VR acceptance:Our study highlights the significance of social factors derived from theories of aging, such as Selective Optimization with Compensation (SOC) and Socioemotional Selectivity Theory (SST), in influencing VR acceptance among LTC residents. Rehabilitation programs should take into account these social aspects and create a supportive and encouraging environment for older adults to engage with VR exergames. Encouraging social interactions and providing opportunities for residents to share their experiences with VR gaming may enhance acceptance and overall engagement.Tailoring VR exergames for older adults:The correlation between VR acceptance and the use of SOC strategies indicates that customized experiences may be well-received by LTC residents. Game developers and rehabilitation specialists should consider designing VR exergames that align with the specific preferences and needs of older adults. This could involve providing choices and options for users to optimize their gaming experiences based on their individual abilities and interests.Recognizing gaming experience:Our study highlights that prior gaming experience positively influenced participants' attitudes towards VR gaming. Rehabilitation professionals should acknowledge and leverage this prior experience when introducing VR exergaming to older adults in LTC. By incorporating elements familiar to older adults or providing guidance for those new to gaming, rehabilitation programs can foster a more seamless and enjoyable transition to VR exergames.Promoting goal pursuit and valued activities:Our study suggests that VR exergaming has the potential to encourage LTC residents' engagement in valued activities and goal pursuit. Rehabilitation programs can utilize VR exergaming as a means to help residents achieve specific rehabilitation goals and engage in activities that are meaningful to them. This approach can contribute to a sense of purpose and satisfaction in the rehabilitation process.Overall, the integration of VR exergaming in rehabilitation for older adults in LTC facilities has promising implications for improving physical activity levels, enhancing engagement, and addressing the holistic well-being of residents. By considering the social factors influencing VR acceptance and tailoring experiences to individual preferences, rehabilitation professionals can optimize the potential benefits of VR technology in LTC settings.

Acceptance of physical activity virtual reality games by residents of long-term care facilities: a scoping review.

PURPOSE: This scoping review aims to identify evidence on older adults' acceptance of PA VR games in LTC facilities, describe research designs used, define key acceptance concepts, and identify knowledge gaps for future research. MATERIALS AND METHODS: Following Arksey and O'Malley's framework, data from published and unpublished articles (Jan 2000-May 2023) were collected. Twelve databases and additional sources were searched for studies on LTC residents (≥65 years), PA video games (including VR and console games), acceptance, and attitudes. Data extraction included article details, design, population, intervention, outcomes, and limitations. RESULTS: Five studies met inclusion criteria from 1628 initial titles. They assessed acceptance of PA VR games among older adults in LTC facilities, showing varying levels of acceptance. Most studies used analytical designs, including RCTs. Key concepts of VR acceptance were poorly defined, with only one study using a validated TAM questionnaire. Knowledge gaps highlight the need for further research to understand PA VR acceptance among older adults in LTC facilities. CONCLUSION: Validated acceptance questionnaires are needed in study of VR acceptance by older adults. Use of qualitative and quantitative methods can enhance understanding of technology acceptance, alongside exploration of individual, environmental, and age-related factors. Detailed reporting of VR interventions is recommended to comprehend acceptance factors.

Enhancing engagement: We suggest that physical activity (PA) virtual reality (VR) games can improve engagement among long-term care (LTC) residents. By providing a novel approach to rehabilitation, PA VR games have the potential to increase motivation and participation, leading to improved outcomes.Promoting physical and cognitive stimulation: VR games offer opportunities for both physical and cognitive stimulation. By integrating these games into rehabilitation programs, we can provide a more engaging and interactive experience for individuals undergoing rehabilitation. This can contribute to motor skills development, balance training, cognitive function, and overall well-being.Addressing barriers to rehabilitation: Traditional rehabilitation approaches may face various barriers, such as lack of interest, adherence issues, or limited resources. The use of VR games can help overcome some of these barriers by offering a more enjoyable and accessible rehabilitation experience. This is particularly beneficial for individuals with mobility limitations or those residing in LTC facilities.In summary, our study highlights the potential of incorporating VR games into rehabilitation settings. By implementing these findings, we can improve the acceptance and efficiency of rehabilitation practices, leading to better rehabilitation outcomes for individuals.

Policymaker perspectives on self-management of disease and disabilities using information and communication technologies.

BACKGROUND: Policies that support health self-management are malleable and highly dependent on various factors that influence governments. Within a world that is shifting toward digitalization due to pressures such as the COVID-19 pandemic and labor shortages, policymaking on older adults' self-management of chronic diseases and disability using information and communication technologies (ICTs) needs to be better understood. Using the province of Ontario, in Canada, as a case study, the research question was What is the environment that policymakers must navigate through in development and implementation of policies related to older adults' self-management of disease and disability using information and communication technologies (ICTs)? METHODS: This study used a qualitative approach where public servants from 4 ministries within the government of Ontario were invited to participate in a 1-h, one-on-one, semi-structured interview. The audio-recorded interviews were based on an adapted model of the policy triangle, where the researcher asked questions about the influences from the different sources identified in the model. The interviews were later transcribed and analyzed using a deductive-inductive coding approach. RESULTS: Ten participants across 4 different Ministries participated in the interviews. Participants shared insights on various aspects of context, process and actors that help shape the current content of policies. The analysis revealed that policies, in the form of programs, services, legislation and regulations, are the result of collaborations and dialogue between different actors and get developed and implemented via a set of complex government processes. In addition, policy actions come from a plethora of sectors which all get influenced by several predictable and unpredictable external pressures. CONCLUSIONS: The environment for policymaking in the government of Ontario regarding older adults' self-management of disease and disability using ICTs is one that is mostly reactive to external pressures, while organized within a set of complex processes and multi-sectoral collaborations. The present research helped us to understand the complexity of policymaking on the topic and highlights the need for increased foresight and proactive policymaking, regardless of which governments are in-place.

Evolution of public health policy on healthcare self-management: the case of Ontario, Canada.

BACKGROUND: As people live longer, they are at increased risk for chronic diseases and disability. Self-management is a strategy to improve health outcomes and quality of life of those who engage in it. This study sought to gain a better understanding of the factors, including digital technology, that affect public health policy on self-management through an analysis of government policy in the most populous and multicultural province in Canada: Ontario. The overarching question guiding the study was: What factors have influenced the development of healthcare self-management policies over time? METHODS: Archival research methods, combining document review and evaluation, were used to collect data from policy documents published in Ontario. The documents were analyzed using the READ approach, evaluated using a data extraction table, and synthesized into themes using the model for health policy analysis. RESULTS: Between January 1, 1985, and May 5, 2022, 72 policy documents on self-management of health were retrieved from databases, archives, and grey literature. Their contents largely focussed on self-management of general chronic conditions, while 47% (n = 18/72) mention diabetes, and 3% (n = 2/72) focussed solely on older adults. Digital technologies were mentioned and were viewed as tools to support self-management in the context of healthcare delivery and enhancing healthcare infrastructure (i.e., telehealth or software in healthcare settings). The actors involved in the policy document creation included mostly Ontario government agencies and departments, and sometimes expert organizations, community groups and engaged stakeholders. The results suggest that several factors including pressures on the healthcare system, hybrid top-down and bottom-up policymaking, and political context have influenced the nature and implementation timing of self-management policy in Ontario. CONCLUSIONS: The policy documents on self-management of health reveal a positive evolution of the content discussed over time. The changes were shaped by an evolving context, both from a health and political perspective, within a dynamic system of interactions between actors. This research helps understand the factors that have shaped changes and suggests that a critical evidence-based approach on public health policy is needed in understanding processes involved in the development of healthcare self-management policies from the perspective of a democratic governing system.

Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review.

BACKGROUND: Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE: This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS: A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS: The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS: Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.

Multilevel barriers to using assistive technology devices among older hispanics from poor and disadvantaged communities: the relevance of a gender analysis.

PURPOSE: To get a rich description of the barriers to using assistive technology (AT) among men and women ≥65 years living in poor and disadvantaged communities in Puerto Rico, an issue not well described among older people. METHODS: We conducted qualitative interviews assisted by videos of AT and guided by the Matching Person and Technology Model and the Gender Analysis Framework with a purposive sample of 23 men and women. Participants were asked questions regarding reasons for not using AT, willingness for using AT, their identified gender roles and gender-related activities, and bargaining positions. They were also asked about their access to resources to acquire AT, bargaining positions, the stigma associated with AT use, and the characteristics of AT. Directed content analysis with input from a Community Advisory Board was used for the interpretation of the results. RESULTS: The predominant barrier (for both men and women) to using AT devices were: lack of information about AT s and access to money for their purchase, lack of availability and cost of such devices, and (self)-stigma. More women than men experienced limited access to AT services, limited access to and control of money, limited skills for using AT, and less bargaining power for making independent decisions. More men than women expressed a lack of functional need and personal preferences other than using AT devices for managing difficulties in activities. CONCLUSION: There are gender differences concerning the multilevel barriers to using AT devices among older Hispanics residing in low-income communities.IMPLICATIONS FOR REHABILITATIONOlder Hispanic men and women in this study experienced different obstacles to using assistive technology (AT) they need for compensating their functional disabilities in daily living activities.Women in this study reported having less access to money and AT services, diminished skills for using AT devices, and less power to make independent decisions to access AT devices compared to men.To ensure the equitable provision of AT, cultural as well as gender-related factors concerning AT use need to be considered.Future research should focus on women's functional health, also should focus on the development of gender-sensitive and culturally competent AT interventions to improve older Hispanics from poor communities function and opportunities for ageing at their homes and in their communities.

The role of assistive technology in addressing social isolation, loneliness and health inequities among older adults during the COVID-19 pandemic.

PURPOSE: Assistive technology (AT) is an effective tool to promote social connectedness among older adults affected by the COVID-19 pandemic; however, its role in reducing loneliness and health inequities is not well understood. The goal of this scoping review was to construct a model for how technologies may be deployed to mitigate the impact of the COVID-19 pandemic on social isolation, loneliness and health inequities for older adults. METHODS: PubMed, SCOPUS and PsychINFO were searched from 2010 to 2020 for the following keywords: "social isolation," "loneliness," "social support," "resilience," "technology," "pandemic" and "health inequit*." Articles selected for full analysis attempted to understand how technology alleviates social isolation and/or loneliness among older adults. RESULTS: Eighteen articles met the criteria for selection and data extraction. Six were review-type studies, seven were observational, three were randomized control trials, one opinion piece and one case study. ATs have been shown to reduce loneliness and social isolation, strengthen social support, and promote resilience among older adults. AT reduces loneliness both directly and indirectly, by affecting social isolation. There is insufficient evidence to determine technology's relationship to health inequities experienced by older adults. CONCLUSIONS: The model we have proposed should help advance research on the relationship between ATs and health inequities among older adults that may be aggravated by the COVID-19 pandemic. We hypothesize that AT interventions for social support and functional competence should be sequenced to reduce health disparities.Implications for rehabilitationThe social distancing and quarantine measures as a result of the COVID-19 pandemic can be linked to adverse health outcomes among older adult populations.Technology is an effective tool to promote social connectedness among older adults affected by the pandemic.Assistive technology (AT) interventions for social support and functional competence should be sequenced in order to have best effects on reducing health disparities.

Older adults' use of an online decision support system: Usability and stability of assistive technology recommendations.

Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive. OBJECTIVE: We evaluated recommendations stability and usability of an online DSS. METHODS: Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards. RESULTS: Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system. DISCUSSION: Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations. CONCLUSION: It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability.

Towards improving the quality of assistive technology outcomes research.

BACKGROUND: The Assistive Technology Device Outcomes Research (ATDOR) checklist was developed as a reporting guideline for researchers to enhance the quality of research in this field. The checklist contains 13 items that cover outcome domains unique to assistive technology devices (ATDs). The ATDOR was intended to be an adjunct to existing publication guidelines for outcomes research. PURPOSE: The aim of this investigation was to examine the ability of the ATDOR checklist to identify strengths and weaknesses in ATD outcomes research publications that may not be detected using another publication guideline designed for outcomes research. METHODS: Twenty original ATD outcome studies were scored using the Template for Intervention Description and Replication (TIDieR) checklist, and the ATDOR in two evaluation rounds. In the first round, articles were scored using the TIDieR alone. In the second round, they were scored using the TIDieR and ATDOR together. The difference in percentage scores between the two evaluation rounds was examined using the Wilcoxon signed rank-sum test for paired data. RESULTS: There was a statistically significant difference in the percentage scores between the two evaluation rounds (Wilcoxon statistic = 10, Z = -3.547, p<.000). CONCLUSION: When used alongside the TIDieR, the ATDOR adds significant value to evaluations of reporting quality on assistive technology outcomes research. As this field continues to grow, researchers are invited to join in efforts to standardise reporting to promote healthier outcomes for ATD users.Implications for rehabilitationReporting guidelines that evaluate research studies enhance their reporting quality and promote healthier outcomes for ATD users.The Assistive Technology Device Outcomes Research (ATDOR) checklist was shown to be a useful tool for achieving a minimum standard of reporting in the field of assistive technology.As the field of assistive technology continues to explore different methodologies, ongoing efforts to develop and update reporting guidelines are necessary in order to capture the future needs of this research area.

Sex disparities in the prevalence of physical function disabilities: a population-based study in a low-income community.

BACKGROUND: Functional disability continues to be a significant public health problem that increases older adults' vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of functional disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities. METHODS: We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS® Physical Function Short Form-20 T-score. The selected community was reported to have 5980 adult residents ≥65 years, according to the USA Census. The prevalence of functional disability was estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalence was compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design. RESULTS: We recruited 211 older Hispanics from a randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The overall estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. However, sex differences were largely explained by the presence of musculoskeletal conditions of high impact in functional disability. CONCLUSIONS: The females in our study bear the greater burden of physical function disability in their adult age. Health policies, as well as future studies, should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender-sensitive disability self-management programs.

Toward guidelines for reporting assistive technology device outcomes.

PURPOSE: The aim of this study was to develop and pilot-test reporting guidelines for manuscripts describing studies of assistive technology device outcomes, with the hopes of improving the overall quality of research in this field. METHODS: The research is presented in two stages. In Stage 1, a literature review was completed to identify the essential components of a conceptual framework for reporting guidelines and to create a checklist. In Stage 2, two independent reviewers evaluated twenty articles using the checklist to identify any short-comings of the tool and produce an estimate of interrater reliability. Two items of the original checklist were revised after reconciling disagreements between the two raters. RESULTS: The Cohen's Kappa value of the checklist was 0.887 (p < .000), reflecting excellent interrater agreement. The overall percent agreement was 94.6%. CONCLUSIONS: Reporting guidelines for studies of assistive technology device outcomes appear to be reliable. Although the checklist may require periodic updating, it has potential for advancing outcomes research. Researchers are invited to share comments and criticisms to aid in the efforts of enhancing the quality of reporting in this field.Implications for rehabilitationReporting checklists and guidelines are effective tools for achieving a minimum standard of reporting quality in all areas of rehabilitation research.This study presents a preliminary reporting checklist for the field of assistive technology device outcomes that has potential for advancing outcomes research.Authors and journal editors are encouraged to adopt and adhere to reporting guidelines in order to enhance the clarity and completeness of prospective studies.

Understanding the Multilevel Disability Self-Management Strategies of Puerto Rican Older Men.

Aims: To explore the person, environment, and occupation-related self-management strategies used by older Hispanic men to cope with disabilities in different types of daily activities. Methods: A concurrent transformative mixed method design (with priority given to the qualitative phase) guided by the Environment and Occupational Performance Model was used to collect and analyze data of 12 participants with functional disabilities. Quantitative data was gathered using the PROMIS Physical Function Short Form-20. Qualitative data was obtained from in-depth semi-structured interviews on participants' self-management strategies. Results: The average T-score (35.96) was below the national average. Participants reported higher levels of functional disabilities in instrumental activities of daily living (IADL), and predominantly used practical social support and change in method of performance to manage their difficulties in self-care, IADL, and functional mobility activities. Conclusions: These strategies may be used with similar populations to design interventions aimed at increasing older Puerto Rican's function.

Collaborative engagement of Hispanic communities in the planning, conducting, and dissemination of assistive technology research.

INTRODUCTION: Community engagement (CE) is critical for research on the adoption and use of assistive technology (AT) in many populations living in resource-limited environments. Few studies have described the process that was used for engaging communities in AT research, particularly within low-income communities of older Hispanic with disabilities where limited access, culture, and mistrust must be navigated. We aimed to identify effective practices to enhance CE of low-income Hispanic communities in AT research. METHODS: The community stakeholders included community-based organizations, the community healthcare clinic, the local AT project, and residents of the Caño Martín Peña Community in San Juan, Puerto Rico. The CE procedures and activities during the Planning the Study Phase comprised working group meetings with stakeholders to cocreate the funding proposal for the study and address the reviewers' critiques. During the Conducting the Study Phase, we convened a Community Advisory Board to assist in the implementation of the study. During the Disseminating the Study Results Phase, we developed and implemented plans to disseminate the research results. RESULTS: We identified seven distinct practices to enhance CE in AT research with Hispanic communities: (1) early and continuous input; (2) building trusting and warm relationships through personal connections; (3) establishing and maintaining presence in the community; (4) power sharing; (5) shared language; (6) ongoing mentorship and support to community members; and (7) adapting to the changing needs of the community. CONCLUSION: Greater attention to CE practices may improve the effectiveness and sustainability of AT research with low-income communities.

Understanding adherence to assistive devices among older adults: a conceptual review.

Purpose: The aim of this study was to identify and examine how existing literature has conceptualized adherence to assistive devices (ADs) among older adults. Methods: English articles were searched in MEDLINE, PubMed, and CINAHL (January 1990 to October 2017) for the key words "acceptance", "adherence", "assistive devices", "compliance", "concept," and relevant synonyms. Bibliographies of selected articles were also examined. Articles were analyzed if the following conditions were met conjointly: (1) attempted to define or conceptualize adherence to some degree; (2) were concerned with any AD for older adults; (3) were concerned with adults aged 65 years or older. Results: Sixteen of the 484 articles were included. Adherence to ADs among older adults seemed to be conceptualized under three core themes: psychological, contextual, and functional factors; each with their own unique considerations related to adherence that are analyzed in this study. Conclusion: This review identified a large gap in knowledge about adherence to ADs. Adherence is multi-factorial and highly specific to the individual's circumstances and their relationship with their health care practitioner. Further empirical research should focus on how the three core themes of adherence interact with and influence each other. Implications for rehabilitation Health care professionals who assess for, and recommend ADs should foster a shared decision-making relationship with their clients This review identifies some of the key themes that practitioners should consider when developing and implementing AD regimens with older adults Conceptualizing AD adherence among older adults will help improve monitoring of and quality of care for AD users.

Reliability, convergent validity and applicability of the Assistive Technology Outcome Profile for Mobility for middle-aged and older power wheelchair users.

BACKGROUND/AIM: The Assistive Technology Outcome Profile for Mobility (ATOP/M) was designed to isolate the impact of mobility assistive technology on perceived difficulty with activity and participation. The study objectives were to examine its measurement properties (test-retest reliability and convergent validity) and applicability for middle-aged and older power wheelchair (PWC) users. METHODS: Four ATOP/M subscales were administered using computer adaptive testing (activity with mobility device, activity without mobility device, participation with mobility device, participation without mobility device). Test-retest reliability (4-wk interval), convergent validity (a priori hypothesis testing of correlations with participation (Late-life Disability Instrument) and mobility (Life-space Assessment)) and applicability (respondent burden, distributions) were examined with 116 PWC users between 50 and 85 years of age presenting with a variety of diagnoses. RESULTS: When using powered mobility, perceived difficulty with activity and participation scores were similar to the general population of mobility devices users (T-score range 46.3-53.7), while activity and participation were significantly lower without mobility devices (T-score range 35.3-39.4). Test-retest reliability intra-class coefficients of the four subscales ranged between 0.82 and 0.91, and convergent validity was supported by moderate correlations (r = 0.35-0.47). Respondent burden was higher for the without devices subscales and none of the subscales had significant floor/ceiling effects. CONCLUSION: Our results provide support for reliability and convergent validity of the ATOP/M for PWC users. Specific strategies were recommended to optimise applicability with this population such as administration guidelines for reframing the without device scale and timing of data collection.

Effects of a caregiver-inclusive assistive technology intervention: a randomized controlled trial.

BACKGROUND: The principal aim of this study was to investigate whether a caregiver-inclusive assistive technology intervention improved older care recipients' functional autonomy and decreased the perceived burden of their family caregivers compared to customary care. METHODS: The study was a single-blind, mixed-methods, randomized controlled trial with baseline data collection and follow-ups at 6-, 22-, and 58-weeks after baseline evaluation, which was prospectively registered ( ClinicalTrials.gov Identifier: NCT01640470. Registered 11/21/2011). Dyads comprising a care recipient and family caregiver were randomly assigned to either a caregiver-inclusive experimental group (N = 44) or a customary-care comparison group (N = 46). Eligible care recipients were aged ≥55 years and had one or more limitations with mobility or daily activities, and family caregivers provided at least four hours per week of assistance. Outcome measures were administered to both groups at baseline and at the three follow-up time points. The data collectors were blinded regarding participants' intervention group. The primary outcome measures were the Functional Autonomy Measurement System to assess care recipients' functional performance, and the Caregiver Assistive Technology Outcome Measure to assess caregivers' burden. Qualitative interviews examined participants' perceptions of the caregiver-inclusive and customary care interventions. RESULTS: The experimental intervention addressed significantly more dyad-identified problematic activities, but caregiver involvement was evident in both groups and outcomes were not significantly different over time. In both groups, care recipients' functional autonomy declined significantly (P < .01), and caregivers' activity-specific and overall burden decreased significantly (P < .01). CONCLUSIONS: Given the unintended congruence between the caregiver-inclusive and customary care interventions, the overall findings lend support for the provision of assistive technology to reduce caregiver burden.

Assistive technology unmet needs of independent living older Hispanics with functional limitations.

PURPOSE: To identify: (1) the most frequently used assistive technology (AT) by a sample of community-living older Hispanics; (2) their AT needs; (3) the AT that would not be used by the simple; and (4) the factors associated with the willingness to use AT. MATERIALS AND METHODS: We used a cross-sectional descriptive study design with a purposive sample of 60 individuals 70 years and older living in Puerto Rico. Data collection tools included a socio-demographic questionnaire and the Assistive Technology Card Assessment. We used descriptive statistics to identify the sample AT use and needs, χ2 to determine the frequency distribution of the socio-demographic variables and the Spearman's rank correlation coefficient (rho) to describe the strength of the association between these variables and the willingness to use AT devices. RESULTS: The sample had unmet needs for AT devices for cooking, home tasks and home safety. A higher number of health conditions as well as having low educational levels were associated with willingness to use AT devices. CONCLUSIONS: Policy implications are discussed supporting the role of rehabilitation professionals, state government and community-based programmes, including the Area Agencies on Aging, in providing culturally relevant AT education and accessibility to assistive devices. Implications for rehabilitations Hispanic older adults with functional limitations living independently in Puerto Rico have unmet needs for AT devices to compensate for physical limitations and increase safety performance, predominantly in instrumental activities of daily living. New policies need to be developed to advocate for increased healthcare coverage of low tech AT devices that could be highly beneficial to older people with functional limitations. Community-based programs administered by the state government, the Area Agencies of Aging, or operated through Medicare need to be developed to provide education, training, loans, purchasing, and delivery of low AT devices that can compensate for older people functional limitations.